Unfavorable long-term results of rectosigmoid neocolpopoiesis

We report on unfavorable long-term results after rectosigmoid neocolpopoiesis in 12 patients, as well as on possible prevention and treatment of these results. To prevent neovaginal introitus stenosis, the rectosigmoid mucosa should be sutured to the perineal skin in an exaggerated interdigital fashion. In cases where introitus stenosis has developed, pedicled transposition flaps from perineum or labia or from the gluteal or inguinal plica region have to be used. Similar flaps also may be applied in cases of rectovagina fistulas. Neuromas at the mucosa-perineal junction often are resistant to therapy. So-called diversion colitis may be manifested by mucous discharge, mucosal bleeding, or discomfort. This disorder may be treated successfully by local application of a solution containing short-chain fatty acids. Loperamidehydrochloride (Imodium) administered half an hour before intravaginal penetration may be helpful to weaken or even prevent neovaginal contractions. Because of the possible higher risk of neovaginal adenocarcinoma, long-term follow-up of these patients is indicated.