Efficacy and safety of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia: a pilot study

Abstract

Background: Hysterectomy places a huge physical and mental burden on young female patients with congenital cervical and complete vaginal atresia. Thus, it is necessary to develop a method to detach the obstruction and simultaneously preserve the vagina and uterus in these patients. This study sought to evaluate the efficacy and safety of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia.

Methods: Between April 2013 and June 2022, 9 patients with congenital cervical and complete vaginal atresia at Henan Provincial People's Hospital were enrolled in this prospective study. All the patients were treated with laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty. Baseline clinical features (such as age, uterus size, etc.) were collected. The surgical success rate and adverse events were assessed.

Results: The 9 enrolled patients had a median [interquartile range (IQR)] age of 15.0 (14.0-18.0) years, and 5/9 patients presented with pelvic adhesions. The surgeries were successful in all (9/9) patients, who preserved their vagina and uterus with a normal menstrual cycle. After a median follow-up duration of 48 months, the neovagina had a median length of 7.5 cm. Post-surgical complications occurred in 3/9 patients, which were cured by an appropriate treatment. The 5/9 married patients reported being satisfied with their sexual life.

Conclusions: Even though the current study preliminary exhibits the efficiency of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia, due to the small sample size, lack of a control group, and relatively high incidence of the adverse events, further studies are still needed to verify the current findings. The current study put forward a further direction for preserving the vagina and uterus simultaneously for those patients with congenital cervical and complete vaginal atresia.

Keywords: Cervical atresia; cervicoplasty; complete vaginal atresia; laparoscopic surgery; vaginoplasty.