Ileocecal vaginal construction.

Area of Science:

• Reconstructive surgery
• Gynecologic surgery
• Gastrointestinal surgery

Background:

• Vaginal reconstruction is challenging in patients with congenital anomalies or post-surgical/traumatic loss.
• Previous reconstructive methods may fail, necessitating alternative surgical approaches.
• Mayer-Rokitansky syndrome, male pseudohermaphroditism, and post-Wertheim-Meigs or trauma-induced vaginectomy present unique reconstructive difficulties.

Purpose of the Study:

• To describe the operative technique for neovagina creation using ileocecal or cecal segments.
• To evaluate the efficacy of this technique in patients with complex anatomical conditions and prior surgical failures.
• To review and discuss current vaginal replacement techniques.

Main Methods:

• Neovagina creation using isolated cecal or ileocecal segments in 10 patients.
• Utilizing the terminal ileum for lengthening the neovagina when necessary.
• Detailed operative technique description and review of existing vaginal replacement methods.

Main Results:

• Successful neovagina creation in all 10 patients, including those with prior failed reconstructions.
• Excellent blood supply and long vascular pedicle from the ileocecal region.
• Tensionless anastomosis achieved, even in patients with difficult anatomies, by supplementing with terminal ileum.

Conclusions:

• Ileocecal and cecal vaginoplasty are effective techniques for vaginal reconstruction, particularly in complex cases.
• The technique provides robust vascularity and allows for tension-free anastomosis, improving outcomes in challenging patient populations.
• This method offers a viable solution for patients with congenital vaginal absence or acquired loss due to trauma or oncologic surgery.