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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.09.018 Byline: Ali M. El Saman, Mohamed M.F. Fathalla, Mahmoud S. Zakherah, Omar M. Shaaban, Ahmed Nasr Keywords: balloon vaginoplasty; laparoscopy; retropubic vaginoplasty; vaginal aplasia Abstract: We studied the feasibility of performing balloon vaginoplasty (BV) with conventional laparoscopic instruments through 2 modified techniques aiming at providing BV for open use. Three of 6 cases with vaginal aplasia were offered modified laparoscopically assisted balloon vaginoplasty (LAB-V) and the other 3 cases underwent modified retropubic balloon vaginoplasty (RBV). We measured operative time, complications, anatomical outcomes, functional outcomes, and re-intervention rates. Modified RBV and LAB-V were performed successfully in the 6 cases within 9-12 and 29-38 min, respectively. The neovagina depths were 8-10 and 9-12 cm, respectively. Anterior rectal wall needle puncture was encountered in 1 case of LAB-V group and posterior urethral wall puncture in an abnormally dilated urethra in 1 case of the RBV group; both cases passed uneventfully. Intercourse was initiated after removal of all catheters. The neovagina was a cosmetically appealing mimic to nature and stained with iodine up to its apex. It was feasible to perform balloon vaginoplasty operations without specialized instrument sets with comparable outcomes. Author Affiliation: Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Article Note: (footnote) Cite this article as: El Saman AM, Fathalla MMF, Zakherah MS, et al. Modified balloon vaginoplasty: the fastest way to create a natural neovagina. Am J Obstet Gynecol 2009;201:546.e1-5.