MAYER-ROKITANSKY-KUSTER-HAUSER SYNDROME. LAPAROSCOPIC SIGMOID VAGINOPLASTY FOR THE TREATMENT OF VAGINAL AGENESIS - SINGLE CENTER EXPERIENCE IN GEORGIA. CASE REPORT.

Abstract

Introduction and hypothesis: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, and short recovery time. We investigate the feasibility, safety, and clinical therapeutic effect of laparoscopic sigmoid vaginoplasty in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Intestinal vaginoplasty has several advantageous features, such as scarless surgery, low incidence of contraction of the reconstructed vagina, maintenance of vaginal depth, spontaneous mucus production, and a low rate of complications. Therefore, this technique is becoming popular in many countries. Following the global trend, the demand for intestinal vaginoplasty for girls suffer from vaginal atresia and transsexuals is also increasing in Georgia. However, there are few reports on intestinal vaginoplasty in Tbilisi. In this article, we examined the safety and effectiveness of rectosigmoid colon vaginoplasty in the population. To avoid vaginal, prolapse, it is important to decide the length of the rectosigmoid segment so that a pull on it does not cause it to become lax, while excessive stress on the feeder vessels is avoided.

Methods: In September 2023, With the participation of plastic surgeons, laparoscopic treatment of total vaginal aplasia was performed on women aged 23 years, with normal female karyotype and typical secondary sex characteristics. diagnosed with MRKHs because of primary amenorrhea. The diagnosis, which has an estimated prevalence of 1 in 5000 live female births, is frequently made during adolescence after tests for primary amenorrhea Results: Operation was performed under general anaesthesia. The patient was placed in the fog leg position to permit access to the perineum. The operating time was 165 min. The hospital stay was 7 days. A functional neovagina was created 11-15 cm in length and two fingers in breadth in our patient. No introitus stenosis was observed. No intra- or post-operative complications occurred. None had complained of local irritation or dyspareunia. Patient had post-surgery sexual intercourse was satisfied with her sexual life and the mean total Female Sexual Function Index (FSFI) score was 25.17±0.63. The cosmetic result was excellent.

Conclusions: The laparoscopic sigmoid vaginoplasty can achieve the goal of making a functional neovagina. The main advantage of this surgical technique is that it is minimally invasive and that there are fewer complications of post-operation. It is an acceptable procedure for patients with MRKH syndrome.