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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
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Step 3: Mobilizing the SPF into the neovaginal space
The peritoneal flap (still attached at the umbilicus) is pulled through the neovaginal space using two Allis clamps with
laparoscopic assistance. The peritoneum is placed over a glass mold and sewn in place with 3–0 absorbable suture. The
glass mold should measure 9 cm long and 3 cm wide, with a conical shape and an opening on top of the mold to allow
drainage of fluid (Beijing Jayyalife Biological Technology Co Ltd, China, MN 99200842). The vaginal mold should be
sterilized before use by soaking it in a 0.5% iodophor solution.
The SPF-covered mold is placed in the neovaginal space and the distal end is sutured to the neovaginal introitus. The glass
mold is removed and replaced by a soft paraffin gauze (not commercially available; soft paraffin gauze dressing tampon)
wrapped by a condom of 9 cm length and 3 cm width.
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Step 4: Creati ng the top of the neovagina
Laparoscopically, a purse-string suture is placed on the top part of the mold to close the SPF using 2–0 polysorb. The
proximal ends of the cut peritoneum are sutured between the round ligaments in order to prevent prolapse.
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POSTOPERATIVE CARE
The Foley catheter and vaginal paraffin gauze remain in place for 48 hours and are then removed. The gauze is replaced by
a glass mold measuring 9 × 3 cm.
Dilation is performed continuously for 3 months postoperatively and after that only at night. Once the patient is sexually
active on a regular basis, the mold can be used less often.
Conjugated equine estrogen cream (0.625 mg) is applied twice daily to the mold in order to facilitate epithelialization. This
local treatment is continued until intercourse occurs.
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OUTCOME: RESULTS AND COMPLICATIONS
Followup in the original study by Zhao et al. occurred for up to 46 months in all 83 patients. No intraoperative complications
were reported. Postoperative complications include stenosis of the introitus in 8.4% of patients (resolved with mechanical
dilation), formation of granulation tissue at the apex in 17% (resolved after trimming), and excessive mucous production in
13% of patients during the first 3 months after surgery (resolved spontaneously).
Anatomic success was noted in all patients at 6 months, and functional success as assessed by the Female Sexual Function
Index (FSFI) questionnaire was reported in 95.3% of patients.
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PEARLS AND PITFALLS
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POSTOPERATIVE CARE
Immediate postoperative care specific to each procedure is listed separately above. Long-term postoperative care issues are
listed here and apply to all of the different techniques:
All women who have undergone vaginal reconstruction need to be given the usual precautions with regard to sexual
transmitted infection (STI) prevention.
During their annual exams, a vaginal speculum exam should be performed to evaluate for any malignancies (especially if
skin grafts or sigmoid colon were used), colitis, or ulcerations (especially if sigmoid colon was used).
There is insufficient evidence for HPV vaccination, and routine gynecologic cytology is not recommended.
5
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OUTCOMES
The outcomes differ with each procedure and are listed separately above. Each procedure has advantages and disadvantages.
More important than the anatomic outcome is the functional outcome.
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COMPLICATIONS
Intraoperative complications include bleeding and damage to adjacent structures. Postoperative and long-term complications
include fistula formation, strictures, scarring, as well as graft failure. If regular sexual intercourse does not occur, intermittent
dilation is important. Details to complications specific for each procedure are listed separately above.
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KEY REFERENCES
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treatment. Obstet Gynecol. 2013;121:1134–1137.
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creation of a neovagina in patients with Mayer-Rokitansky-Kuester-Hauser syndrome. Fertil Steril. 2015;104:241–247.
29. Benedetti Panici P, Maffucci D, Ceccarelli S, et al. Autologous In Vitro Cultured Vaginal Tissue for Vaginoplasty in women
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