Laparoscopic Assisted Neo-Cervico-Vaginal Anastomosis by Rail-Road Procedure In Cervico-Vaginal Atresia

Cervico-vaginal atresia is a rare entity, difficult to diagnose and treat, with a higher rate of complications. It is classified as type 1b mullerian anomaly per ASRM and subclass C4 per ESHRE classification. The increased rate of re-stenosis and sepsis makes the surgery challenging. Also, the young adolescent age group makes compliance difficult, necessitating an empathetic yet efficient approach. We aim to compare and observe the two repair techniques: laparoscopic v/s open. A stepwise narrative protocol describing this modified technique, which uses a key-hole fundal incision to reach the endometrial cavity, drain the collected menstrual blood, and use the rail-road method to produce a neo-cervico-vaginal anastomosis. A total of 15 cases have been performed, with significant symptom relief (p < 0.01). The outcome measures are relief of symptoms, regularity of menses, adequate vaginal length, and stenosis. The procedure employed is a variation on previously performed hysterotomies, a rather invasive procedure. As a result, the rate of postoperative infection and morbidity has decreased dramatically. It has achieved a successful long-term outcome, with no patients requiring hysterectomy; hence, it has emerged as a promising approach that maintains anatomical and functional integrity, preserves future fertility, and reduces the risk of adolescent endometriosis. Technically, despite being a challenging procedure, laparoscopic repair has an edge over the open technique due to its minimally invasive nature, thereby emerging as a promising tool for a better future.