title: Bowel vaginoplasty in children and young women: an institutional experience with 55 patients.
abstract: OBJECTIVE
  Absence of a vagina owing to congenital Mullerian defects or other acquired causes requires reconstruction of the female genital passage. We present our experience using various bowel segments.
  
  
  METHODS
  Bowel vaginoplasty was performed in 55 patients from January 2004 through May 2014 for cervicovaginal atresia (20), Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (20), distal vaginal atresia (8), cloaca (2), cervical atresia (1), complex urogenital sinus (1), transverse vaginal septum (1), rhabdomyosarcoma of the vagina (1), and traumatic stricture of the vagina (1). The bowel segments used were sigmoid (50), ileum (2), anorectovestibular fistula ( 2), and loop rectovaginoplasty (1).
  
  
  RESULTS
  Thirty-nine patients who had the proximal vagina or uterus anastomosed to the bowel segment reported regular menstrual flows. Three patients are sexually active with satisfactory coital function. None of our patients developed pyometra. Five patients had neovaginal mucosal prolapse. Two patients had severe stenosis requiring excision of the neovagina. Seven patients had mild stenosis requiring dilatations in 6 patients and V-Y meatoplasty for 1 patient. One patient had a descending colon anastomotic leak requiring a diversion ileostomy.
  
  
  CONCLUSIONS
  Genital reconstruction with bowel vaginoplasty is a highly skilled operation that provides a durable and lubricated replacement of the vagina with good outcomes. Utero-coloneovaginoplasty is a safe procedure preserving the menstrual flow in patients with a functional uterine fundus.
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004. skisku@yahoo.com.
authors.forename: Sundeep
authors.identifier: http://orcid.org/0000-0003-1051-2395
authors.initials: S
authors.lastname: Kisku
authors.affiliation: Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India, 632004.
authors.forename: Lilly
authors.initials: L
authors.lastname: Varghese
authors.affiliation: Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India, 632004.
authors.forename: Aruna
authors.initials: A
authors.lastname: Kekre
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004.
authors.forename: Sudipta
authors.initials: S
authors.lastname: Sen
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004.
authors.forename: Sampath
authors.initials: S
authors.lastname: Karl
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004.
authors.forename: John
authors.initials: J
authors.lastname: Mathai
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004.
authors.forename: Reju Joseph
authors.initials: RJ
authors.lastname: Thomas
authors.affiliation: Department of Paediatric Surgery, Christian Medical College, Vellore, India, 632004.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kishore
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000637:transplantation*; D005260:Female; D006801:Humans; D007223:Infant; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D014564:Urogenital Abnormalities / Q000601:surgery*; D014621:Vagina / Q000002:abnormalities*; D055815:Young Adult
keywords: Colovaginoplasty; MRKH; Rhabdomyosarcoma of the vagina; Vaginal reconstruction