Thirty-six vaginal constructions: lessons learned
OBJECTIVES: The use of bowel for vaginal construction is a well-established procedure. In this paper, the lessons learned from 36 vaginoplasties over a 34-year period are discussed. METHODS: Between 1980 and 2013, 36 patients between 1 and 21 years of age underwent vaginal construction. In 27 of the 36 patients, an inverted V-shaped perineal skin flap was incorporated into the posterior wall of the neovagina, and, when required, a detubularized pouch was used to avoid traction on the vascular pedicle. In nine patients, the sigmoid colon was anastomosed, in a circumferential manner, to the short blind-ending vaginal dimple. RESULTS: Two of the nine sigmoid vaginas, where the perineal skin flap was omitted, developed introital stenosis. None of the sigmoid neovaginas that included the perineal flap developed stenosis. One patient with ileal segment vagina, at the onset of puberty, developed introital stenosis after 10 years; this was successfully corrected. Nineteen out of 28 patients available for long-term follow up were sexually active and reported no dyspareunia. CONCLUSIONS: Detubularization and reconfiguration to form a pouch reduces the traction on the mesentery of the bowel segment, which ensures adequate blood supply to the distal entero-cutaneous junction. The inverted V-shaped perineal skin flap should be incorporated in the anastomosis to avoid circumferential suture line and introital stenosis.