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Long-Term Follow-Up after Laparoscopic Uterovestibular Anastomosis in Patients with Cervical Atresia and Complete Absence of the Vagina

Published:April 27, 2022DOI:https://doi.org/10.1016/j.jpag.2022.04.008

      ABSTRACT

      Background

      The surgical treatment of girls with cervical atresia and complete absence of the vagina remains a problem because of the rarity of cases and the controversial study results.

      Objective

      To describe the surgical technique and long-term results of laparoscopically assisted uterovestibular anastomosis in patients with cervical atresia and complete absence of the vagina

      Study Design

      Sixteen consecutive patients with cervical atresia and complete absence of the vagina were conservatively treated with laparoscopically assisted uterovestibular anastomosis in 2 tertiary care referral centers. The follow-up assessments included clinical examination, determination of the presence and quality of sexual intercourse, and vaginoscopy.

      Results

      All patients underwent laparoscopically assisted uterovestibular anastomosis. No perioperative complications occurred. The mean follow-up period was 8 ± 3.2 years. In all patients, the length of the neovagina was greater than 4 cm at 1 year after the surgery and approximately 6 cm after 2 years. After the start of sexual intercourse, the neovagina exceeded 7 cm in length in 2 of the 11 sexually active patients. At 12 months after the surgery, iodine-positive epithelium was present in all patients and was maintained over time. The continuity of the neovagina, neocervix, and uterine body was maintained without further interventions in 15 of the 16 patients. During the follow-up, 11 patients were sexually active, 5 were married, 4 were seeking conception, and 2 had spontaneous pregnancy.

      Conclusions

      Laparoscopically assisted uterovestibular anastomosis seems to be a safe and effective treatment for patients with cervical atresia and complete absence of the vagina, at least in terms of the recovery of menstrual function and sexual activity.

      Key Words

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      References

        • Fujimoto VY
        • Miller JH
        • Klein NA
        • Soules MR:
        Congenital cervical atresia: report of seven cases and review of the literature.
        Am J Obstet Gynecol. 1997; 177: 1419-1425
        • Grimbizis GF
        • Tsalikis T
        • Mikos T
        • et al.
        Successful end to end cervicovaginal anastomosis in a patient with congenital cervical fragmentation: case report.
        Hum Reprod. 2004; 19: 1204-1210
        • Buttram Jr:, VC
        Mullerian anomalies and their management.
        Fertil Steril. 1983; 40: 159-163
        • Farber M
        • Marchant DJ:
        Reconstructive surgery for congenital atresia of the uterine cervix.
        Fertil Steril. 1976; 27: 1277-1282
        • Niver DH
        Barrette G, Lewlewiwichz R: Congenital atresia of the uterine cervix and vagina: three cases.
        Fertil Steril. 1980; 33: 25-29
        • Geary WL
        • Weed JC:
        Congenital atresia of the uterine cervix.
        Obstet Gynecol. 1973; 42: 213-217
        • Mikos T
        Gordts G, Grigoris F, Grimbizis GF: Current knowledge about the management of congenital cervical malformations: a literature review.
        Fertil Steril. 2020; 113: 723-732
        • Rock JA
        • Roberts CP
        • Jones Jr:, HW
        Congenital anomalies of the uterine cervix: lessons from 30 cases managed clinically by a common protocol.
        Fertil Steril. 2010; 94: 1858-1863
        • Rock JA
        • Reeves LA
        • Retto H
        • et al.
        Success following vaginal creation for Mullerian agenesis.
        Fertil Steril. 1983; 39: 809-813
        • Fedele L
        • Bianchi S
        • Berlanda N
        • et al.
        Neovaginal mucosa after Vecchietti's laparoscopic operation for Rokitansky syndrome: structural and ultrastructural study.
        Am J Obstet Gynecol. 2006; 195: 56-61
        • Fedele L
        • Bianchi S
        • Frontino G
        • et al.
        Laparoscopically assisted uterovestibular anastomosis in patients with uterine cervix atresia and vaginal aplasia.
        Fertil Steril. 2008; 89: 212-216
        • Vecchietti G:
        Die Neovagina beim Rokitanksy-Küster-Hauser-Syndrom [Neovagina in Rokitanksy-Küster-Hauser syndrome].
        Gynakologe. 1980; 13: 112-115
        • Fedele L
        • Bianchi S
        • Berlanda N
        • et al.
        Neovaginal mucosa after Vecchietti's laparoscopic operation for Rokitansky syndrome: structural and ultrastructural study.
        Am J Obstet Gynecol. 2006; 195: 56-61
        • Rotter CW:
        Surgical correction of congenital atresia of the cervix.
        Am J Obstet Gynecol. 1958; 76: 643-646
        • Iversen S:
        Atresia cervicis uteri congenita [Congenital atresia of the uterine cervix].
        Nord Med. 1966; 75: 41-42
        • Zarou GS
        • Esposito JM
        • Zarou DM:
        Pregnancy following the surgical correction of congenital atresia of the cervix.
        Intb J Gynaecol Obstet. 1973; 11: 143
        • Deffarges JV
        • Haddad B
        • Musset R
        • Paniel BJ:
        Utero-vaginal anastomosis in women with uterine cervix atresia: long-term follow-up and reproductive performance. A study of 18 cases.
        Hum Reprod. 2001; 16: 1722-1725
        • Chakravarty B
        • Konar H
        • Chowdhury NN:
        Pregnancies after reconstructive surgery for congenital cervicovaginal atresia.
        Am J Obstet Gynecol. 2000; 183: 421-423
        • Kannaiyan L
        • Chacko J
        • George A
        • Sen S:
        Colon replacement of vagina to restore menstrual function in 11 adolescent girls with vaginal or cervicovaginal agenesis.
        Pediatr Surg Int. 2009; 25: 675-681
        • Rezaei Z
        • Omidvar A
        • Niroumanesh S
        • Omidvar A:
        Cervicovaginal anastomosis by Gore-Tex in Mullerian agenesis.
        Arch Gynecol Obstet. 2015; 291: 467-472
      1. McIndoe A: The treatment of congenital absence and obliterative conditions of the vagina.
        Br J Plast Surg. 1950; 2: 254
      2. Bedner R, Rzepka-Gorska I, Blogowska A, et al: Effects of a surgical treatment of congenital cervicovaginal agenesia.
        J Pediatr Adolesc Gynecol. 2004; 17: 327-330
        • El Saman AM:
        Combined retropubic balloon vaginoplasty and laparoscopic canalization: a novel blend of techniques provides a minimally invasive treatment for cervicovaginal aplasia.
        Am J Obstet Gynecol. 2009; 201 (e1-5): 333
        • Zhang Y
        • Chen Y
        • Hua K:
        Outcomes in patients undergoing robotic reconstructive uterovaginal anastomosis of congenital cervical and vaginal atresia.
        Int J Med Robot. 2017; 13: 1821
        • Dornelas J
        • Jármy-Di Bella ZI
        • Heinke T
        • et al.
        Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation.
        Eur J Obstet Gynecol Reprod Biol. 2012; 163: 204-209