Sigmoid colon vaginoplasty in children

Area of Science:

• Surgical Reconstruction
• Pediatric Surgery
• Gynecology

Background:

• Vaginal construction is essential for patients with Mullerian duct aplasia, testicular feminization, and androgen insensitivity syndromes.
• Several methods for vaginal construction exist, with sigmoid colon vaginoplasty being a notable technique.

Purpose of the Study:

• To evaluate the surgical technique and outcomes of sigmoid colon vaginoplasty in adolescent patients.
• To assess the efficacy and suitability of sigmoid colon neovagina for congenital vaginal anomalies.

Main Methods:

• Six adolescent patients (mean age 16) with 5alpha-reductase deficiency, testicular feminization, or vaginal atresia underwent sigmoid vaginoplasty.
• A 15-20 cm segment of sigmoid colon was used, creating a retrovesical tunnel and anastomosis to the vaginal plate or rudimentary vagina.
• Postoperative care included daily vaginal irrigation; examination and calibration under anesthesia were performed without routine dilatation.

Main Results:

• Five of six patients experienced an uneventful recovery with excellent cosmetic results and appropriate vaginal length.
• One patient developed late introitus stenosis, successfully treated with dilatations.
• A single patient with vaginal atresia (Bardet-Biedl syndrome) suffered severe complications including deep vein thrombosis, renal failure, and sepsis, leading to death.

Conclusions:

• Sigmoid colon vaginoplasty is a suitable procedure for constructing a neovagina in children, offering adequate length, diameter, and self-moistening capabilities.
• The technique results in less perineal scarring and adaptability to existing structures, reducing the need for routine dilatation.
• While generally safe, potential morbidities include those associated with laparotomy and serious complications from underlying conditions.