Vaginal Reconstruction with Laparoscopic-perineal Rectosigmoid Colpopoiesis in Mayer-Rokitansky-Kuster-Hauser Syndrome: A Case Report.

Bae, Sung Gun; Lee, Sang Yun; Cho, Byung Chae; Choi, Kyu Seok

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2011;38(3):333-337.
Published online May 1, 2011.

Vaginal Reconstruction with Laparoscopic-perineal Rectosigmoid Colpopoiesis in Mayer-Rokitansky-Kuster-Hauser Syndrome: A Case Report.

Sung Gun Bae, Sang Yun Lee, Byung Chae Cho, Kyu Seok Choi

¹Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, Daegu, Korea. bccho@knu.ac.kr
²Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.

Abstract

PURPOSE
Various operations have been proposed to compensate for congenital absence of the vagina using ileal or colonic interposition. These methods involve laparotomy, which shows postoperative complications such as long scar and delayed recovery. One case of neovagina reconstruction with laparoscopic rectosigmoid colpopoiesis in Mayer-Rokitansky-Kuster-Hauser syndrome is presented to avoid laparotomic complications. METHODS: Laparoscopic surgery was performed in a 27-year-old MRKH syndrome patient. After a cruciate incision, blunt dissection through two-finger wide space was created between the bladder and the rectum. A 14-cm rectosigmoid segment vascularized by a branch of sigmoid artery was isolated by laparoscopy. The distal end was sutured with vaginal vestibule mucosa. A continuity of intestine was restored by circular end-to-end proximate curved intraluminal stapler CDH29(R) through perineal opening.
RESULTS
Total operation time was 4 hr 15 min. Normal walking and ingestion were possible within 3 days and 4 days after surgery. The hospital stay was 7 days and the patient was followed up for 6 months. The neovaginal introitus was wide enough for inserting two fingers, and there has been no narrowing of the neovagina on palpation as confirmed by vaginogram. The patient had functional self-lubricating neovagina without excessive mucous production or the need for routine dilation or unnoticeable scar.
CONCLUSION
The successful result of this laparoscopic vaginal reconstruction technique with rectosigmoid segment suggests that this technique can be considered for the option of vaginal reconstruction in girls with the MRKH syndrome.

Keywords: Laparoscopy; Vagina; Procedure; Reconstructive surgical; Rectosigmoid