Peritoneal vaginoplasty by Luohu I and Luohu II technique: a comparative study of the outcomes

Abstract

Background: Surgical vaginoplasty is the standard treatment for women suffering from Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. This study compares the advantages and disadvantages of Luohu I technique or its modification, Luohu II technique.

Methods: Women with MRKH syndrome undergoing laparoscopic peritoneal vaginoplasty using either the Luohu I (N = 145) or Luohu II (N = 155) technique were recruited. We compare the effectiveness of the Luohu II and one of Luohu I. Sexual satisfaction was checked by Female Sexual Function Index.

Results: There was no significant difference in the mean operation time, volume of intraoperative blood loss, time for the first passage of gas, sexual satisfaction (and hospital stay for patients in either group (P > 0.05). But patients in the Luohu II group had a significantly lower incidence of complications than patients in the Luohu I group. All patients had vaginal depths more than 9 cm over 3 months post-surgery.

Conclusions: Compared with the traditional Luohu I laparoscopic peritoneal vaginoplasty, the Luohu II operation is easier to perform and causes less damage to the bladder and rectum. The physiological and anatomical features of the artificial vagina resemble the normal vagina in both techniques.

Fig. 1

6 vaginal dilatation rods (mold) whose diameters are 2.2, 2.5, 2.8, 3.0, 3.3, 3.5 cm, length is 20 cm (use in operation)

Fig. 2

a A puncture needle for epidural anesthesia connected to a 20 ml syringe inserted through the middle of the vaginal vestibule. b The puncture needle inserted through the gap between the bladder and the rectum toward the peritoneum beyond the fiber cord. c The water cushion formed by injecting physiological saline solution containing pituitrin and epinephrine. The cushion helps to divide the peritoneum at the pelvic floor and rectum. d The vestibule mucosa divided using medium-sized, curved pliers. Then the vaginal tunnel is formed by extending the incision using the clinician’s finger. e A mold inserted through the vaginal tunnel. f The peritoneum at the end of the mold incised using an electric scalpel. The incision is extended by the mold and a larger mold is used to dilate the vaginal tunnel. g The clinician guiding the peritoneum downward using his finger on the incision margin of the peritoneum as a guide toward the vaginal opening by the pliers. h The vaginal opening sutured at four points (3, 6, 9, and 12 o’clock). i A mold being put in the vaginal tunnel and purse-string sutures used to close the pelvic cavity

Fig. 3

vaseline gauze wrapped mold

Fig. 4

The clinician forcing the rod through the vaginal tunnel to push the pelvic peritoneum at the bladder rectum lacunae toward the vaginal opening

Fig. 5

3 vaginal dilatation rods (mold) which diameters are 2.2, 2.5, 2.8 cm, length is 20 cm (use after operation)