Meutia Alfa P, Harzif Achmad Kemal, Priyatini Tyas, Moegni Fernandi, Hakim Surahman, Djusad Suskhan
Division of Urogynecology, Reconstruction and Aesthetic Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2023 May;106:108164. doi: 10.1016/j.ijscr.2023.108164. Epub 2023 Apr 13.
There are many methods described in the literature for creating a functional neovagina. However, the best method has yet to be determined. In our urogynecology training center, neovaginoplasty was usually performed by vaginal approach using modified McIndoe technique with amnion graft and >7 days hospitalization was required. However, we tried to combine both vaginal and laparoscopic modified technique of neovaginoplasty to improve the functional and surgical outcome as well as shortened hospital stay.
A 27-year-old woman came to our center with a chief complaint of primary amenorrhea and she was diagnosed with vaginal agenesis as part of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. She underwent neovaginaplasty using a combined vaginal and laparoscopic approach with autologous peritoneal graft. Patient was discharged the next day. The follow up result (6-24 months) was excellent with total vaginal length was 8 cm and FSFI score 34.5.
The use of peritoneal graft using a laparoscopic approach for vaginal reconstruction was chosen in this case after proper counseling with the type of vaginal mucosal lining as the primary consideration. We combined our routine vaginal approach technique with laparoscopic approach to provide an autologous peritoneal graft and considered modifying the technique by extending the peritoneal dissection laterally to facilitate mobilization of the peritoneum to cover the whole surface of neovagina.
Combined vaginal and laparoscopic modified technique of neovagina creation may present as treatment option for MRKH patients with excellent anatomical and functional result, minimal surgical complication and shorter hospital stay.
文献中描述了许多创建功能性新阴道的方法。然而，最佳方法尚未确定。在我们的泌尿妇科培训中心，新阴道成形术通常采用经阴道途径，使用改良的麦金杜技术并植入羊膜移植片，住院时间需超过7天。然而，我们尝试将经阴道和腹腔镜改良技术相结合，以改善功能和手术效果，并缩短住院时间。
一名27岁女性因原发性闭经为主诉前来我们中心就诊，她被诊断为阴道发育不全，这是 Mayer-Rokitansky-Küster-Hauser（MRKH）综合征的一部分。她接受了经阴道和腹腔镜联合途径的新阴道成形术，并使用了自体腹膜移植片。患者于次日出院。随访结果（6 - 24个月）良好，阴道总长度为8厘米，性功能指数（FSFI）评分为34.5。
在经过适当咨询后，考虑到阴道黏膜衬里类型，本病例选择了使用腹腔镜途径植入腹膜移植片进行阴道重建。我们将常规的经阴道途径技术与腹腔镜途径相结合，以提供自体腹膜移植片，并考虑通过向外侧扩展腹膜剥离来改良技术，以利于腹膜的移动，从而覆盖新阴道的整个表面。
经阴道和腹腔镜联合改良技术创建新阴道可能是MRKH患者的一种治疗选择，具有良好的解剖和功能效果、最少的手术并发症以及较短的住院时间。
