Sigmoid reconfigured vaginal construction in children

Area of Science:

• Pediatric Surgery
• Urology
• Genitourinary Reconstruction

Background:

• Neovaginal construction is essential for gender affirmation and reconstructive surgery in children.
• Traditional techniques can face challenges with pedicle viability and achieving adequate caliber.

Purpose of the Study:

• To present a modified sigmoid neovaginal construction technique in pediatric patients.
• To protect the sigmoid pedicle, allow caliber adjustment, and reorient the mucosal fold longitudinally.

Main Methods:

• A modified Yang-Monti concept was used for intestinal reconfiguration in 10 genetically male children (ages 1-13).
• Indications included androgen insensitivity, congenital adrenal hyperplasia, and bladder exstrophy with sex reassignment.
• The technique involved sigmoid segment utilization for neovagina creation.

Main Results:

• Eight children achieved an adequate neovaginal caliber after initial dilation.
• One case of stricture required successful reoperation.
• Another child developed a mid-segment stricture, managed with ongoing dilation.

Conclusions:

• The modified sigmoid reconfiguration technique facilitates the creation of a long vaginal conduit with adequate caliber.
• This approach allows for the use of smaller intestinal segments.
• Future assessment is needed to evaluate the long-term adequacy for penetration after sexual activity begins.