Laparoscopic Sigmoid Vaginal Replacement

Abstract

At the April 2000 International Pediatric Endosurgery Group (IPEG) meeting we presented the first patient to undergo laparoscopic sigmoid vaginal replacement. Here we update our experience with this procedure in 14 consecutive patients.

The mean age of our patients was 16.3 years. Eleven patients had Mayer Rokitansky syndrome and 3 were male pseudohermaphrodites.

A total of 4 ports was used: a 10 mm umbilical port, a 12 mm port in the right lower quadrant, and two 5 mm ports (left lower quadrant and hypogastric). The lens was initially introduced through the umbilical port and afterwards inserted through the right lower quadrant port in order to achieve a better visualization of the vascularization of the sigmoid. After isolating a segment of the sigmoid using endoclips, bipolar or ultrasonic devices, and two endostaplers, we undertook a perineal dissection, creating a space between the urethra and the rectum under laparoscopic vision. Colo-colonic anastomosis was achieved using a circular mechanical suture through the rectum and taking outwards the proximal end of the colon through the umbilicus. Both the joining and stapling were done under laparoscopic control. The peritoneum near the pouch of Douglas was incised in order to allow the passage of a forceps from the perineum to enable the descent of the isolated bowel.

Mean operative time was 3.5 hours. There were no intra- or postoperative complications except for one accidental opening of the bladder, which was sutured laparoscopically. All patients were able to tolerate food after 24 hours and 11 were discharged 48 hours after the operation. Viability and patency of the neovagina are excellent after a mean follow-up of 6 months (range, 4–36 months), and 5 patients are sexually active.