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Study Objective To compare results of 3 original techniques of laparoscopically assisted colpopoiesis from the pelvic peritoneum. Design Prospective Level II study. Setting Department of Operative Gynecology, National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of Russia. Patients or Participants We recruited 226 patients with utero-vaginal aplasia (MRKH). Interventions We used colpopoiesis from the peritoneum of the pelvis, developed by Adamyan, as a treatment method for patients with uterine and vaginal aplasia (MRKH). Since 2012, neovagina creation has been undertaken utilizing three different methods: laparoscopic-perineal technique, total laparoscopic technique, and combined laparoscopic-perineal technique with ligatures used to lower the peritoneum. Measurements and Main Results A total of 81 patients underwent colpopoiesis using the laparoscopic-perineal technique, employing in 105 cases a total laparoscopic colpopoiesis technique and in employing in 40 case a laparoscopic-perineal technique with ligatures. Rudimentary uterine horns were found in 37 patients. 18 percent had kidney dystopia, of which 12% had a pelvic kidney, and 10% had kidney aplasia. There were no significant differences between the three types of colpopoiesis in terms of blood loss, the duration of surgery, the length of stay in the postoperative hospital, and the use of painkillers in the postoperative period. In terms of complications, there was 1 case of bladder injury, and 1 case of rectal injury in patients with prior fibrosis was diagnosed and repaired during surgery. Postoperative neovaginal stricture was observed in 5 cases, and dyspareunia in 11 cases, which improved with the expansion of the vagina within 1 month. Conclusion Laparoscopy Involving neovagina creation is an effective and safe operation, even in patients with unsuccessful previous neovagina attempts and radiation-induced fibrosis, which provides sufficient length of neovagina of 10-12 сm, functional aspects such as lubrication, epithelialization, extensibility, and sensitivity. However, such interventions, especially in complex cases, should be provided only in specialized medical centers.

Congenital absence of vagina and uterus has been eponymously called Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The vagina may appear as a dimple with the presence of rudimentary uterine primordia and normal functioning ovaries. Its incidence is 1 in 4500 to 5000 female. Patients present with primary amenorrhea, normal external genitalia, and well-developed secondary sexual characteristics. Davydov’s colpopoiesis is one of the methods of vaginoplasty using the patient’s own peritoneum as a graft to line the neovagina. We present here a case of MRKH Syndrome where a laparoscopic Davydov procedure was chosen for vaginal reconstruction.

For women with congenital vaginal agenesis and sexual needs, creating a functioning neovagina is a practical therapeutic schedule. Colpopoiesis using the sigmoid intestine were more reported in the literatures. Though the incidence of neovaginal prolapse (NP) is relatively low (3-8%), it does bring great inconvenience to patients, and expose gynecologists to tough challenges. Hereon, we report a case of NP 10 years after sigmoid colon vaginoplasty that was successfully repaired by laparoscopic sacro-colpopexy with a mesh, hoping to provide meaningful evidence for this rare situation.

Study Objective To compare results of 3 original techniques of laparoscopically assisted colpopoiesis from pelvic peritoneum. Design Level II-1, Canadian Taskforce. Setting Department of Operative Gynecology, National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of Russia Patients or Participants We recruited 203 patients with utero-vaginal aplasia, gonadal dysgenesis, testicular feminization, congenital adrenogenital disorders, male-to-female transgenders. Interventions Adamyan's technique of laparoscopically assisted colpopoiesis from pelvic peritoneum has been used for more than 30 years. Since 2012, we have used three original methods of laparoscopic neovagina creation from pelvic peritoneum: laparoscopic-perineal technique, total laparoscopic technique and combined laparoscopic-perineal technique with ligatures used for bringing down the peritoneum. Measurements and Main Results Total of 71 patients underwent colpopoesis using a laparoscopic-perineal technique: in 94 cases - total laparoscopic technique of colpopoiesis and in 38 - laparoscopic-perineal technique with ligatures were used. 27 patients had history of unsuccessful attempts for surgical neovagina creation. There were no significant differences between three types of colpopoesis in blood loss, duration of surgery, length of postoperative hospital stay and in use of pain relievers postoperatively. From the standpoint of complications, 1 case of bladder injury, 1 case of rectal injury in patients with previous fibrosis were diagnosed and eliminated during surgery followed by asymptomatic recovery. Postoperative neovaginal stricture was seen in 5 cases and dyspareunia was seen in 11 cases, which improved with vaginal maintenance dilation within 1 month. Conclusion Laparoscopy Involving neovagina creation is an effective and safe operation even in patients with unsuccessful previous neovagina attempts and radiation induced fibrosis.which provides sufficient length of neovagina of 10-12 сm, functional aspects such as lubrication, epithelialization, extensibility and sensibility. However, such interventions especially in complex cases should be provided in the specialized medical centers.

Mayer–Rokitansky–Kuster–Hauser (M–R–K–H) syndrome is a rare congenital anomaly of the female genital tract. A number of techniques have been described for the formation of a neovagina, however, a standardized treatment does not yet exist. To evaluate three surgical procedures for colpopoiesis in patients with M–R–K–H syndrome, we design a retrospective study based on record of clinical data in our university hospital. Eighteen patients with M–R–K–H syndrome were performed colpopoiesis by Ruge's, McIndoe's, and laparoscopically assisted Davydov's procedures. We compare with three surgical procedures in terms of operative success rate, operation time, total bleeding loss during operation, perioperative complication rate, and long-term complications. The postoperative vaginal depth showed no significant difference among the three procedures. Operation success rate was 50.0% in Ruge's procedure, 88.9% in McIndoe's procedure, and 100% in laparoscopically assisted Davydov's procedure. The duration of McIndoe's ...

Surgical creation of a neovagina using the sigmoid was one of the main techniques used in patients with Mayer–Rokinatsky–Kuster–Hauser syndrome. Nowadays, this surgery is not common as a result of the high frequency of complications and adverse outcomes, one of which is sigmoid neovagina prolapse. There are no standards of treatment because of the rarity of these clinical events; therefore, any medical case is important. We present a case report of a 72-year-old patient with prolapse of the sigmoid stump. Perscrutation of this example allows us to conclude that laparoscopic sacrocolpopexy is the optimal operation for patients with apical prolapse and a history of sigmoidal colpopoiesis owing to its high level of safety and excellent outcomes.

The aim of these case reports is to present the feasibility of isthmo-neovagina anastomosis after Davydov's colpopoiesis in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) with a rudimentary uterine horn. Ten MRKH patients were treated surgically with laparoscopic Davydov's vaginoplasty between 2006 and 2012. Two of these patients were found to have a functional rudimentary uterine horn. These patients underwent a 2-step surgical intervention: (1) Davydov's colpopoiesis with a combined laparoscopic and perineal approach and (2) isthmo-neovagina anastomosis with laparotomy in the 2 cases with a uterine horn in a second surgical step 4 and 6 months after the initial procedure, respectively. The main outcome measures were the perioperative and postoperative details, the vaginal length during follow-up, the postoperative initiation of intercourse, and the postoperative menstrual function. Isthmo-neovagina anastomosis was uneventful, and there were no early postoperative complications. The mean hospitalization duration was 9.5 days. Anastomosis was successful in both patients. The mean follow-up was 42 months, and the mean vaginal length was measured 9.5 cm; both patients reported normal intercourse and normal menstrual function. Anatomic restoration of the genital tract in these patients appears to have been successful and led to functional menstruation and restitution of the patients' sex life.

Background: Laparoscopic removal of a rudimentary uterus that has functional endometrium and colpopoiesis in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome have been done at the same operation. Case: Removal of rudimentary uterus was relatively uncomplicated under laparoscopy. Colpopoiesis (creation of the neovagina with the modified Davydov's procedure) was possible after the resection procedure. Extraction of the rudimentary uterus via the neovagina during colopopoiesis was possible. Peritoneal denudation of the rudimentary uterus resection did not influence peritoneal suturing. Conclusions: The presence of peritoneal endometriosis was remarkable, especially in the apparent absence of an identifiable connection between the uterine cavity and fallopian tube. (J GYNECOL SURG 26:201)

BACKGROUND: Colpopoiesis using the sigmoid colon may be used in treatment of patients with Mayer-Rokitansky-Kuster-Hauser syndrome. Prolapse of a sigmoid neovagina is rare and its treatment is not yet standardized. CASES: Two patients developed severe prolapse of a neovagina derived from the sigmoid colon. One patient underwent resection of the redundant sigmoid and an abdominal suspension procedure; however, the prolapse has recurred. The other patient was treated by removal of the entire sigmoid artificial vagina. An alternative neovagina was reconstructed with a pudendal thigh flap. She has no signs of recurrent prolapse and is satisfied with sexual intercourse. CONCLUSION: Replacement therapy by a connected skin graft may be an excellent optional method as a radical treatment for prolapse of a sigmoid neovagina.

Purpose: We present a novel surgical treatment for secondary hematocolpos in adolescent girls with high vaginal atresia.Materials and Methods: Vaginoplasty was performed in 5 girls 12 to 14 years old with high vaginal atresia. The operation included the perineal approach, mobilization of hematocolpos and plastic surgery of the distal portion of the vagina using a U-shaped mucous-submucous vaginal flap, and introital and labial flaps.Results: There were no complications 4 to 6 months after the operation. There were no instances of cosmetic defects and stenosis.Conclusions: The proposed technique reduces the difficulty and trauma of the operation for high vaginal atresia with hematocolpos and an absent distal portion of the vagina. An increase in plastic reserve provided by the original mobilization of hematocolpos and U-shaped vaginal flap makes intestinal and skin colpopoiesis unnecessary.