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Dual-Force Vaginoplasty for Treatment of Segmental Vaginal Aplasia

El Saman, Ali M. MD; Farag, Mohamad A. MD; Shazly, Sherif A. MBBCh; Noor, Mohamed MD; Ali, Mohammed K. MD; Othman, Essam R. MD; Khalifa, Mansour MD; Farghly, Tarek A. MD; El Saman, Dina A. MS

doi: 10.1097/AOG.0000000000001974
Contents: Procedures and Instruments

BACKGROUND: Vaginal aplasia occurs in 1 in 5,000–10,000 female live births. In this report, we evaluated a novel dual-force vaginoplasty technique for treatment of 11 patients with segmental vaginal aplasia.

TECHNIQUE: The principle of the approach is to thin the atretic part between two counteracting forces. The instrument was inserted laparoscopically into the proximal hematocolpos. Two balloon catheters, one for drainage and one for traction, were threaded over the inserter. The traction catheter was then threaded over a silicon tube, leaving the balloon in the proximal portion of the vagina and connecting across the vaginal septum to a fenestrated Teflon olive, which was positioned against the distal surface of the vaginal septum. This created a dual “pushing and pulling” force across the septum, which, over 3–4 days, pulls the upper vaginal pouch down while the vaginal dimple is pushed up. The aplastic segment becomes thin and easy to dilate and permits achievement of vaginal patency. The drainage of the hematocolpos is predominantly through the balloon catheter so postoperative wound management is facilitated.

EXPERIENCE: Eleven menarchal girls were diagnosed with segmental vaginal aplasia. The dual-force vaginoplasty was performed on each and was tolerated well with no operative complications. They all reported establishment of the menstrual cycle and significant improvement of pain during follow-up.

CONCLUSION: Creation of a dual pushing–pulling force on the atretic vaginal segment is a feasible short procedure for management of segmental vaginal aplasia.

Instrumentation to provide pulling and pushing forces for tissue expansion can be used to construct a neovagina for treatment of vaginal segmental aplasia.

Woman’s Health Hospital, Department of Obstetrics and Gynecology, and the Faculty of Medicine, Assiut University, Assiut, the Department of Obstetrics and Gynecology, Banha University, Banha, and the Department of Obstetrics and Gynecology, Sohag University, Sohag, Egypt.

Corresponding author: Ali M. El Saman, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt, PO Box 30, Assiut, Egypt; email: ali_elsaman@yahoo.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Dr. Saba M. Shugaa Al Deen (Department of Obstetrics & Gynecology, University Hospital of Sana'a, Yemen) for her sincere contribution to patients' recruitment and follow-up.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.