Management of recurrent adhesion after vaginal recanalization surgery by using interdigitating Y-flap technique: Case series

Abstract

Introduction: Adhesion is one of complication after vaginal recanalization surgery that occurs due to the free tissue attached during the wound healing process and should be treated carefully. Otherwise, it will become obstruction to the vagina and lead to hematocolpos. The chosen techniques should prevent recurrent adhesion, synechia or stenosis. In this case series, we performed interdigitating Y-flap technique for managing recurrent synechiae post recanalization vaginal surgeries to prevent future stenosis.

Presentation of case: The first case was a 16 years old teenager, complained not menstruating and abdominal pain. Patient already had recanalization vagina surgery for correcting distal vaginal agenesis two years ago. After that, patient already had menstruation. There were hematometra, hematocolpos and vaginal adhesion from examination. The second case was a 12 years old teenager, complained having slight blood menstruation after septum excision surgery. From the examination, there was stenosis vagina at 3 cm proximal from hymenal ring. Both patients were treated by interdigitating Y-flap surgery for correcting the synechiae. After follow up treatment, there was no complaint from patients.

Discussion: Both patients were having synechia post vaginal recanalization surgery. To prevent recurrent synechiae, we decided to do interdigitating Y-Flap technique for correcting synechiae. With this technique, the scar tissue may not develop contractured scar and narrowing vagina.

Conclusion: Interdigitating Y-Flap technique may become an option for managing complex recurrent adhesion, synechia or stenosis. This technique is simple, easier and reduces the risk of stenosis in the future with better scar formations.

Keywords: Case series; Interdigitating Y-flap; Vaginal recanalization surgery; Vaginal stenosis.