Vulvovaginoplasty Treatment Doctors in Kolkata, India

Creation of Neovagina

by Dr. Sankar Dasmahapatra

Laparoscopic Endometriosis surgery treats mild to severe cases by skilled surgeons trained in this method. During the procedure, they'll make a small incision in your abdomen so they can insert a tiny tube with a camera (laparoscope) through it. In some cases, they may need to make more than one small incision.

Background

Girls with androgen insensitivity and vaginal agenesis are born without a functional vagina. There are several surgical methods available to create a neovagina including the McIndoe procedure which entails a skin graft, the Davydov procedure which utilizes peritoneal tissue, the Williams vulvovaginoplasty which uses vulvar tissue, and there is the option to create a vagina from a bowel graft. All these procedures are rather invasive with significant risk of scarring leading to failure of the procedure. The current literature supports dilation of a vaginal dimple as the overwhelmingly preferred method of creating a neovagina. Because of the natural elasticity of the tissues, a vagina can be created by self dilation in 3-6 months. This requires the patient, often a teenage girl, to diligently apply pressure with a dilator twice daily for twenty minutes for 3-6 months to achieve adequate vaginal length. Aside from being excessively time consuming; many girls are adverse to this method of treatment because they are both physically and psychologically uncomfortable with self treatment.

Complications and post-operative period

No intra- or post-operative complications were observed in any of the patients undergoing the surgical procedure. Post-operative recovery was rapid although post-operative need for analgetics was present in patients and ranged from 5 days to intermittent use of oral pain-relieving medication for up to 24 weeks (two of eight patients) with a median time of 11 weeks. Patients were discharged home between days 6 and 15 with a median post-operative stay of 13.8 days.

Conclusion

Taken together, the laparoscopic variant of the Vecchietti operation is a safe and effective method for creation of a neovagina in patients with MRKH. However, regular post-operative dilation of the reconstructed organ either by sexual intercourse or by use of dilators is necessary for satisfying long-term results of the procedure.

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