Pneumovaginal Resection of a Vaginal Septum in Obstructed Hemi Vagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome.

Abstract

Objective To demonstrate surgical excision of a high obstructing vaginal septum using a pneumovaginal approach with the GelPOINT Path Transanal Access Platform. Setting OHVIRA Syndrome is defined by a Müllerian anomaly with a unilateral obstructed hemivagina and associated renal anomaly (1, 2). Resection of a high vaginal septum can be technically challenging from the transvaginal approach, limited by instrument length and introital size in recently menarchal patients, which can result in poor outcomes such as incomplete septum resection and stenosis. Pneumovaginal endoscopic surgery has been performed in 18 previously reported cases, most to treat vaginal erosions of synthetic mesh used for pelvic organ prolapse, with two reported resections of longitudinal vaginal septa described (3-5). Participants An 11-year-old post-menarchal patient presented with uncontrolled abdominal pain due to hematometrocolpos in the setting of OHVIRA syndrome. Interventions The distal aspect of the obstructive vaginal septum was noted to be greater than 5 cm superior to the introitus. She underwent pneumovaginal resection of an obstructing vaginal septum. Conclusion Pneumovaginal resection of an obstructing vaginal septum is a minimally invasive, feasible approach in a young patient with OHVIRA. Application of this surgical technique may result in improved visualization and has potential to result in more complete excision of the vaginal septum in challenging cases.