M. A. B. FAHMY ET AL.425
method is to provide a canal of adequate length, which is
lined with mucous membrane, characterised by a low
tendency to stenosis and comfortable during sexual ac-
tivity. Although used as a first-line of treatment for dec-
ades, skin grafts and dilation techniques are associated
with a high incidence of shrinkage, lack of lubrication
and dyspareunia [10].
Intestinal transplant methods to create a functioning
neovagina were advocated more than 100 years ago; the
advantages of these methods include adequate vaginal
length, natural lubrication, early intercourse and a low
rate of shrinkage [3]. Most segments of the intestinal
tract have been used to create a neovagina, but the sig-
moid colon is particularly useful because it is anatomi-
cally close to t he perineum, it is s ufficiently lon g and the
mobility of its vascular pedicle allows it to be brought
into the perineum [11].
Also the bowel vaginoplasty utilizing sigmoid colon
offers some advantages over skin grafts because of dis-
tensibility and sel f lubricating pro perty with no tendency
for neovagina stenosis, but it has the drawbacks of a
laparotomy with visible scars, possibility of bowel leak-
age/obstruction and problem of mucous secretion [12].
Also the sigmoid segments of the colon could be liable
for inflammatory bowel disease [13], primary adenocar-
cinoma has been reported, so vaginoscopy should be
used for any case of postoperative bleeding, pain, or
suspected mass .There have been reports of mucosal
prolapse, as well as of stenosis [14].
The Vecchietti technique [15] and its laparoscopic
varia nt re quir es a va gina l d i mple o f 3 - 4 c m, a long t ime
and rigorous cooperation by the patients to achieve ac-
ceptable results [15].
In the last decades, due to the progress in anesthesia,
antibiotic use and the reduction of risks associated with
colorectal anastomosis, the sigmoid graft technique has
became the first-line choice for the treatment of vaginal
agenesis in both children and adults [16]. A sigmoid ne-
ovagina is cosmetically pleasing, offers natural lubrica-
tion and during creation can be anchored to prevent
prolapse.
A collective analysis of 202 patients from 7 recent se-
ries of bowel neovaginoplasty found a complication rate
of 35% and a re-operation rate of 4%. These rates of
complications are not comparable to those reported for
skin gr aft vaginoplasties [1 0].
In this study we used the sigmoid graft as a preferable
procedure in 15 patients aged from1 to 8 years (mean 3
years), a historical cohort study of those consecutive pa-
tients who underwent neovagina reconstruction were
presented.
A dedicated database was reviewed for the etiology of
vaginal malformation, surgical complications and post-
operative follow-up, where Androgen Insensitivity Syn-
drome (AIS) was the common cause of vaginal atresia (8
pati ents), 4 had congenital vaginal atresi a (Figure 5).
In this small series the introduction of surgical stapler
for resuming the bowel continuity enabled to shorten the
time of surgery (60 min to 120 min, mean 75), to reduce
the hospital sta y which ranged from 5 to 12 days means 7
days, and we claim that it is al so li mits the complications
of bowel anastomosis to nil.
But other complications encountered in 4 patients, in-
troital stenosis in 2 patients, one of them had a tight
stenosis which necessitates redo of the introital wound,
and 2 cases had minor postoperative wound infection
which managed conservatively with local wash and sys-
temic antibiotic for 5 days without any surgical interven -
tion and without sequels. There were no long term com-
plications or impediment related to bowel anastomosis,
and there is no mortality in this group of patients. All
patients had functional adequate patency and lubricant
neovagina, with good patient satisfaction and the vagina
had fine appearing introits and mucus production de-
creased 3 to 4 month after the operation.
6. Conclusions
Vagina could be reconstructed with better success rate
and low complication rate by using sigmoid colon, it
does not require moulds, dilatation, lubricant, and the
vagina gro ws with t he child and could be used in differ -
ent diagnosed vaginal atresia, especially in girls who
doesn’t expect sexual activity shortly after surgery. The
use of stapler to reestablish the bowel continuity seems
to minimize the time of the technique and decline the
rate of complications related to bowel anastomosis. The
long-term satisfaction with the sigmoid neovagina for
intercourse, especially in girls had their vagina con-
structed before puberty, still requires long-term evalua-
tion.
7. References
[1] D. M. Powell, K. D. Newman and J. Randloph, “A Pro-
posed Classification of Vaginal Anomalies and Their
Surgical Correction,” Journal of Pediatric Surgery, Vol.
30, No. 2, 199 5 , pp. 271-276 .
do i:10.1016/ 0022- 3468( 95)90 573-1
[2] R. T. Frank, “The Formation of an Artificial Vagina with-
out Operation,” American Journal of Obstetrics & Gyne-
cology, Vol. 35, 1938, pp. 1053-1055.
[3] J. F. Baldwin, “The Formation of an Artificial Vagina by
Intestinal Transplantation,” Annals of Surgery, Vol. 40,
No. 3, 1904, pp. 398-403.
[4] J. H. Pratt, “Sigmoidovaginostomy: A New Method of
Obtaining Satisfactory Vaginal Depth,” American Jour-
Copyright © 2011 SciRes. SS