title: Laparoscope-assisted creation of a neovagina using pedicled ileum segment transfer.
abstract: BACKGROUND
  To present our experience of vaginal reconstruction with the use of a pedicled ileum segment and laparoscope assistance, and to analyze its complications and long-term anatomic and functional results.
  
  
  METHODS
  The abdominal and perineal approaches were performed simultaneously with the patient in a special position. Under the guidance of laparoscopy, the target ileal segment was harvested and transposed down to the perineum through an artificial tunnel between the bladder and the rectum. A silicon vaginal tutor was introduced into the vaginal cavity and maintained all day long for 2-3 months. The complications and the anatomical and functional results were summarized and analyzed.
  
  
  RESULTS
  From February 2002 to June 2010, 82 patients underwent laparoscope-assisted total vaginal reconstruction with a pedicled ileum segment at our department. Complications developed in 16 of 82 patients, including rectum and/or bladder injury during operation, acute renal failure, delayed healing of the ileocutaneous anastomosis, introital stenosis, and partial or complete intestinal obstruction. The abdominal cutaneous scar was acceptable after the surgery. The vulva was not altered, which was especially significant for patients with congenital vaginal atresia. The neovagina was patent, soft, moist, and flexible. The mean width and depth of the neovagina at the latest postoperative visit measured 3.2 and 15 cm, respectively.
  
  
  CONCLUSIONS
  The favorable long-term anatomical and functional results demonstrate that our technique is ideal for patients with congenital vaginal atresia or patients who need secondary vaginal reconstruction. For the primary male-to-female transsexuals or hermaphrodites, it can be an alternative method for vaginal construction.
authors.affiliation: Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, People's Republic of China. drzhaoyz@yahoo.com
authors.forename: Yao-Zhong
authors.initials: YZ
authors.lastname: Zhao
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: An-Tang
authors.initials: AT
authors.lastname: Liu
authors.forename: Dao-Zhen
authors.initials: DZ
authors.lastname: Jiang
authors.forename: Xiao-Hai
authors.initials: XH
authors.lastname: Zhu
authors.forename: Ming
authors.initials: M
authors.lastname: Qiu
authors.forename: Xiang-Min
authors.initials: XM
authors.lastname: Zheng
authors.forename: Zi-Hao
authors.initials: ZH
authors.lastname: Lin
authors.forename: Xiang-Bin
authors.initials: XB
authors.lastname: Yuan
authors.forename: Jian-Lin
authors.initials: JL
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D010535:Laparoscopy; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery*; D055815:Young Adult