Search

Vaginoplasty and anoplasty were undertaken in a case (aged 8 years) of imperforate anus and perineal fistula with absence of the vagina by making use of the fistula and rectum and by the pull-through procedure, respectively. The surgical procedures employed are considered to be most appropriate for correction of these deformities. Three years later, however, the patient developed hematometra and hematosalpinx due to a functional uterus present. She underwent hysterectomy combined with left salpingo-oophorectomy. If normal uterus is noted to be present upon laparotomy, it seems important to establish spatial communication between the stump of the vagina constructed and the corpus uteri, to prevent future development of hematometra.

THE treatment of congenital absence of the vagina appears to have exercised the patience and skill of gynaecologists for many years. A glance at the literature shows that there is no settled opinion as to the correct management of the condition, while there are some definitely opposed to its surgical treatment by any existing method. Three procedures have been used by those who are surgically inclined : ( a ) Free gvafts. Heppner,' Abbe,' Flynn,' Kirschner and Wagner,'"' Monod aRd Iselin.' Here free skin grafts, usually in multiple small pieces, are applied to the walls of the cavity made between the rectum and the bladder and maintained there by some form of flexible or rigid mould for 7 to 10 days. At the end of that time the mould is removed and the calibre of the cavity maintained as far as possible by intermittent dilatation. In the words of Monod and Iselin this must be begun early, repeated frequently and prolonged indefinitely. Judging from reported cases the results are indifferent and appear to run parallel with the efficacy of the subsequent dilatation. ( h ) Pediculated paps. Gravesfi first advocated the use of two full thickness pediculated flaps turned up from the thighs and inserted into a pre-formed vaginal cavity. Frank and Geist' modified this as an application of the Gillies tubed pedicle with better results. They stated that the only methods which can compare with it are the Baldwin,8 Mori,' and Schubert'O operations.

During the past six years at the University of Cincinnati Medical Center, we have employed a modification of our standard procedure for vaginoplasty for correction of a congenital urogenital sinus. The technique permits suturing the vaginal mucosa to the skin without tension, creating an adequate vaginal orifice. A triangular skin flap is developed and rotated into a corresponding incision in the urogenital sinus and posterior vaginal wall. The skin flap thus becomes a part of the posterior wall of the vagina. The technique has been employed for 12 children. Nine had congenital adrenal hyperplasia. Three were type 2 female pseudohermaphrodites. A satisfactory vaginal orifice was created in each instance and there were no complications. Technique With the patient under general anesthesia and in the lithotomy position, the perineum is prepared with soap and water and painted wth aqueous benzalkonium chloride (Zephiran) (Fig 1). A curved hemostat is inserted into the