[Comparison of the long-term effects of the conservation surgery for obstructive cervical atresia between using porcine small intestinal submucosal grafts and using autologous lateral femoral split-thickness skin grafts].

Abstract

Objective: To compare the long-term outcomes of cervicovaginal reconstruction between using small intestinal submucosa (SIS) grafts and using autologous lateral femoral split-thickness skin substitutes (STS) grafts. Methods: This was a prospective cohort study, involving 81 patients with obstructive cervical dysplasia who underwent cervicovaginal reconstruction using either SIS or STS grafts from January 2012 to August 2024. Data were collected, including demographic characteristics, operative duration, hospitalization costs, postoperative menstrual recovery, pregnancy outcomes, reoperation rates, vaginal length, and other relevant clinical parameters. Cosmetic satisfaction was assessed via questionnaire at 6th month post-surgery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire after resumption of sexual activity. Differences between the two groups were analyzed. Results: The mean age of overall patients at diagnosis was (16±5) years, with no significant difference between the SIS group [(16±6) years] and the STS group [(16±4) years]. The average operative time was (170.9±76.2) minutes, significantly shorter in the SIS group compared to the STS group [(158.0±67.9) vs (252.6±78.4) min; P<0.001)]. Total hospitalization costs were significantly higher in the SIS group than in the STS group [(4.2±1.4) vs (2.0±0.6) ten thousand yuan; P<0.001]. At a median follow-up of 67 months, all patients resumed menstruation postoperatively. Twelve patients (14.8%) experienced vaginal or cervical restenosis or atresia within 30 months after surgery, and 28 patients (34.6%) required secondary surgery. Specifically, 12 cases (14.8%) underwent repeat vaginal or cervical recanalization, 22 cases (27.2%) experienced intrauterine catheter loss, and 2 cases (2.5%) had failed in conservation due to hysterectomy. The mean postoperative vaginal length was (7.3±1.2) cm, with the SIS group showing significantly shorter vaginal length compared to the STS group [(7.2±1.2) vs (7.9±0.6) cm; P<0.05]. Patients in the SIS group reported higher body image scores and cosmetic satisfaction scores than those in the STS group [(15.9±1.4) vs (14.2±1.5) points, P<0.001; (18.6±2.1) vs (16.8±2.0) points, P=0.009]. Twenty-one patients (25.9%) resumed sexual activity postoperatively, with no statistically significant difference in FSFI scores between the two groups (P>0.05). Eleven patients (13.6%) expressed an intention to conceive, and one patient in the SIS group successfully became pregnant and delivered via assisted reproductive technology. Conclusions: Conservation reconstruction surgery for patients with obstructive cervical dysplasia is safe and effective, allowing patients to resume menstruation, achieve satisfactory sexual life, and achieve pregnancy and childbirth. The method of SIS grafts results in shorter operation times and better aesthetics but at a higher cost.