Double Pedicle Artery Rotation Sigmoid Vaginoplasty for Vaginal Aplasia Management

Abstract

Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.

Keywords: Disorders of sex development; Gynecologic surgical procedures; Rotation; Vaginal aplasia; Wound healing.

Fig. 1.

Vascular pedicle preservation design. Two branches of vascular pedicles from the sigmoid artery and marginal artery of Drummond were planned to be preserved. A1–2, proximal end of sigmoid graft; B1–2, distal end of sigmoid graft; dashed line, site of incision of the isolated sigmoid segment; 2 parallel black lines, site of artery ligation.

Fig. 2.

Preservation of vascular pedicles. A 20-cm sigmoid segment with its 2 pedicle branches of the sigmoid artery and marginal artery of Drummond were preserved.

Fig. 3.

Design of the procedure. The sigmoid segment then was rotated 180° on its vascular supply. The distal end of the isolated colon (B1) was anastomosed to the uterus, and the proximal end (A2) was anastomosed to the vagina. IMA, inferior mesenteric artery; LCA, left colonic artery; SA, sigmoid artery; RA, rectal artery; A1–2, proximal end of sigmoid graft; B1–2, distal end of sigmoid graft; dashed line, site of incision of the isolated sigmoid segment; 2 parallel black lines, site of artery ligation.

Fig. 4.

Anastomosis procedure. Preparation of anastomosis procedure between the distal ends of the isolated colon (B1) with the uterus.