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A new technique for surgical treatment of vaginal agenesis using combined abdominal-perineal approach.

Beksac MS, Salman MC, Dogan NU - Case Rep Med (2011)

Bottom Line: The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis.However, many modifications have been introduced in time in an attempt to increase the success rates.The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.

ABSTRACT
Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

No MeSH data available.


Related in: MedlinePlus

Uterine cavity catheterized with a hysterometer which is pushed downward until neovaginal space was accessed.
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fig4: Uterine cavity catheterized with a hysterometer which is pushed downward until neovaginal space was accessed.

Mentions: After the creation of neovagina, a second surgeon performed a laparotomy via pfannenstiel incision. On exploration, both ovaries and right Fallopian tube were normal. A rudimentary uterine horn was detected on the right side which seemed to be nonfunctioning, and no hematometra or hematosalpinx was evident (Figure 2). On the left side, a relatively enlarged uterine horn and hematosalpinx were seen (Figure 3). Hematoma within the left tube was drained, and neosalpingostomy was performed which was secured via eversion provided by 3.0 polyglactin sutures. A hysterotomy was performed subsequently on right anterolateral fundal portion of left uterine horn. The uterine cavity was identified, and hematometra was drained. The cavity was catheterized with a hysterometer which was pushed slowly downward until neovaginal space was accessed (Figure 4). The hysterometer used was a straight, graduated, and sounding metal hysterometer with a rounded tip which was slightly conical with outside diameters ranging from 3 to 5 millimeters. The specially designed vaginal mold was inserted into the neovagina with an 8-french pediatric Foley catheter placed in its central lumen (Figure 5). The tip of the Foley catheter was located in the uterine cavity, and its balloon was insufflated with 3 mL saline (Figure 6). Endometrium and myometrium were closed separately with 2.0 interrupted polyglactin sutures. To maintain the mold in position, sutures were put in between labia majora and the small holes located at the distal end of the mold with 1.0 polyglactin sutures (Figure 7). Hyalobarrier gel was applied between neovaginal walls and the mold.


A new technique for surgical treatment of vaginal agenesis using combined abdominal-perineal approach.

Beksac MS, Salman MC, Dogan NU - Case Rep Med (2011)

Uterine cavity catheterized with a hysterometer which is pushed downward until neovaginal space was accessed.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3090616&req=5

fig4: Uterine cavity catheterized with a hysterometer which is pushed downward until neovaginal space was accessed.
Mentions: After the creation of neovagina, a second surgeon performed a laparotomy via pfannenstiel incision. On exploration, both ovaries and right Fallopian tube were normal. A rudimentary uterine horn was detected on the right side which seemed to be nonfunctioning, and no hematometra or hematosalpinx was evident (Figure 2). On the left side, a relatively enlarged uterine horn and hematosalpinx were seen (Figure 3). Hematoma within the left tube was drained, and neosalpingostomy was performed which was secured via eversion provided by 3.0 polyglactin sutures. A hysterotomy was performed subsequently on right anterolateral fundal portion of left uterine horn. The uterine cavity was identified, and hematometra was drained. The cavity was catheterized with a hysterometer which was pushed slowly downward until neovaginal space was accessed (Figure 4). The hysterometer used was a straight, graduated, and sounding metal hysterometer with a rounded tip which was slightly conical with outside diameters ranging from 3 to 5 millimeters. The specially designed vaginal mold was inserted into the neovagina with an 8-french pediatric Foley catheter placed in its central lumen (Figure 5). The tip of the Foley catheter was located in the uterine cavity, and its balloon was insufflated with 3 mL saline (Figure 6). Endometrium and myometrium were closed separately with 2.0 interrupted polyglactin sutures. To maintain the mold in position, sutures were put in between labia majora and the small holes located at the distal end of the mold with 1.0 polyglactin sutures (Figure 7). Hyalobarrier gel was applied between neovaginal walls and the mold.

Bottom Line: The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis.However, many modifications have been introduced in time in an attempt to increase the success rates.The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.

ABSTRACT
Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

No MeSH data available.


Related in: MedlinePlus