Laparoscopically assisted uterovestibular anastomosis in patients with uterine cervix atresia and vaginal aplasia.
OBJECTIVE
To describe the surgical technique and the long-term anatomic and functional results of laparoscopically assisted uterovestibular anastomosis.


METHODS
Descriptive study.


METHODS
Tertiary referral center.


METHODS
Twelve consecutive patients with uterine cervix atresia and vaginal aplasia.


METHODS
Laparoscopically assisted uterovestibular anastomosis was performed in all patients. Follow-up assessments at 1, 6, and 12 months included pelvic examination, transvaginal ultrasonography, and, in selected cases, vaginoscopy and hysteroscopy. Subsequent follow up was done by referring physicians or by means of telephone interview. Mean follow-up was 6 years.


METHODS
Intra- and postoperative characteristics and anatomic and functional outcome.


RESULTS
The surgical procedure was successful in all cases and all of the women have experienced regular menstruation. At 6-month follow-up, mean vaginal length was 6 cm and at least 80% of neovaginal epithelium was iodine-positive in all patients. Six women were sexually active during follow-up without difficulty. None have yet attempted to seek a pregnancy.


CONCLUSIONS
The study shows the safety and effectiveness of a laparoscopic approach to uterovestibular anastomosis in women with cervical atresia and vaginal aplasia. In these patients, we believe that conservative surgery should represent the first therapeutic option. A longer follow-up is needed to assess pregnancy rates and outcome.
Fedele
Luigi
L
Department of Obstetrics, Gynecology and Neonatology, Fondazione Policlinico-Mangiagalli-Regina Elena, University of Milan, Milan, Italy. luigi.fedele@unimi.it
Bianchi
Stefano
S
Frontino
Giada
G
Berlanda
Nicola
N
Montefusco
Sarah
S
Borruto
Franco
F
D000293:Adolescent; D000714:Anastomosis, Surgical; D002584:Cervix Uteri / Q000002:abnormalities / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects; D008598:Menstruation; D012725:Sexual Behavior; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014621:Vagina / Q000002:abnormalities / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*