title: Vaginal reconstruction with a greater omentum-pedicled graft combined with a vicryl mesh after anterior pelvic exenteration. Surgical approach with long-term follow-up.
abstract: Resection of anterior vaginal wall that occurs with some cases of anterior pelvic exenteration leaves the patient with a small and narrow vagina. This affects their sexual life leading to major psychologic problems, especially in young women. The aim of this study is to evaluate a new technique of vaginal reconstruction following anterior pelvic exenteration with clinical and cytohistologic follow-up. Between March 2002 and November 2004, ten sexually active female patients underwent vaginal reconstruction after radical cystectomy that required en bloc removal of the anterior vaginal wall, with a pedicle graft of greater omentum combined with a vicryl mesh. The mean age of the patients was 38 years. The mean operative time of the reconstructive procedure was 50 min. There were no complications regarding the reconstructive procedure. On follow-up, the neovagina accepted two fingers easily and showed a pink-colored smooth lining. Seven patients reported successful attempts of sexual intercourse. It was concluded that reconstruction of vagina after anterior pelvic exenteration in sexually active women can be done safely with the use of vicryl mesh combined with a pedicled omental graft. It is a simple, reliable, and not time-consuming technique. The long-term follow-up was very beneficial in detection of complete healing, postoperative infections, and hormonal activity of the graft and recurrence of malignancy.
authors.affiliation: Department of Surgical Oncology and Pathology, National Cancer Institute, Cairo University, Cairo, Egypt. ahmedaffandy@gmail.com
authors.forename: A H
authors.initials: AH
authors.lastname: Elaffandi
authors.forename: H H
authors.initials: HH
authors.lastname: Khalil
authors.forename: H A
authors.initials: HA
authors.lastname: Aboul Kassem
authors.forename: M
authors.initials: M
authors.lastname: El Sherbiny
authors.forename: E H
authors.initials: EH
authors.lastname: El Gemeie
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009852:Omentum / Q000601:surgery / Q000637:transplantation*; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000534:rehabilitation*; D011098:Polyglactin 910; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012725:Sexual Behavior; D013524:Surgical Flaps; D013526:Surgical Mesh; D014621:Vagina / Q000601:surgery*; D014623:Vaginal Diseases / Q000209:etiology / Q000473:pathology
chemical_list: D011098:Polyglactin 910