Laparoscopically assisted biomaterial graft for reconstruction in congenital atresia of vagina and cervix.

OBJECTIVE

To report successful treatment by laparoscopically assisted biomaterial graft for reconstruction in patients with congenital atresia of the uterine cervix and vagina.

DESIGN

Technique and instrumentations.

SETTING

University-based tertiary care hospital.

PATIENT(S): An 18-year-old woman with vaginal agenesis and cervical dysgenesis and a 13-year-old woman with vaginal agenesis and cervical agenesis, both patients with a functional uterus.

INTERVENTION(S): Creation of a neovagina by vaginal procedure and laparoscopically assisted biomaterial graft for uterovaginal anastomosis was performed in all patients.

MAIN OUTCOME MEASURE(S): All surgical findings were carefully reviewed to determine the anatomic characteristics of the malformed cervix. Subsequent follow-up was done by referring physicians.

RESULT(S): Uterovaginal continuity was established successfully in both patients, and all of the women were menstruating normally. Granulomatous polyps occurred in one patient, and this condition was successfully managed. At 6-month follow-up, mean vaginal length was 12 cm and ≥ 80% of neovaginal epithelium was iodine positive in both patients. Unimpeded menstrual flow continued after 4 years of follow-up in one patient and 5 years of follow-up in the other patient.

CONCLUSION(S): A combined laparoscopic and vaginal procedure with biomaterial graft could be an effective alternative in selected women with atresia of cervix and vagina.