Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 3 ( May-June, 2022 ) > List of Articles

Original Article

Comparative Study of Creation of Neovagina Using Skin Graft and Interceed in Mayer–Rokitansky–Küster–Hauser Syndrome

Anuja Vivek Bhalerao, Jitendra Mehta, Prachi Dixit, Snehal Ashok Naphade

Keywords : Mayer–Rokitansky–Küster–Hauser syndrome, McIndoe's technique, Neovagina, Vaginoplasty

Citation Information : Bhalerao AV, Mehta J, Dixit P, Naphade SA. Comparative Study of Creation of Neovagina Using Skin Graft and Interceed in Mayer–Rokitansky–Küster–Hauser Syndrome. J South Asian Feder Obs Gynae 2022; 14 (3):233-237.

DOI: 10.5005/jp-journals-10006-2056

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Objective: This study compared and evaluated the outcomes of using Interceed and skin graft in vaginoplasty for women with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome on the basis of vaginal length (neovagina), procedure safety, patient satisfaction (sexual) after marriage, ease of procedure, procedure time, and morbidity. Materials and Method: Over the course of 18 months, this hospital-based randomized controlled trial was conducted at a tertiary care center. There were 17 women with primary amenorrhea and MRKH syndrome who had undergone vaginoplasty and met the inclusion and exclusion criteria. Nine women received vaginoplasty with Interceed and eight women got vaginoplasty with skin graft, and they were monitored for 6 months postmarriage using a computerized block randomization system. Anatomical and functional outcomes were assessed in these women. The percentage, mean, and standard deviation (SD) were calculated using Epi Info program. For the analysis, the Mann–Whitney and Fischer tests were used. Observations: Women in group A (Interceed) were 22.322 ± 1.59 years old, whereas those in group B (split-thickness skin transplant) were 23.85 ± 1.83 years old. On day 8, the length of the vagina in women who had vaginoplasty with Interceed (Group A) was 8.8330.4153 cm, which was longer than 8.413 ± 0.4190 cm in women who had split-thickness skin transplant (Group B). The vaginal width was determined to be two-finger breadth in both groups. The duration of surgery in women undergoing vaginoplasty with Interceed (Group A) was 32 ± 4.243 minutes as compared to split-thickness skin graft (Group B) where it was 61.38 ± 8.634 minutes. This difference is statistically significant. The functional outcome in relation to sexual satisfaction (lubrication, orgasm, satisfaction, and pain) in women undergoing vaginoplasty with Interceed was 77.8% as compared to 37.5% with Split-thickness skin graft. Conclusion: By using Interceed for vaginoplasty, gynecologist is independent and no separate procedure is required for graft. It is safe, easy, effective, less time-consuming and patient satisfaction with anatomical and functional outcome is good due to squamous epithelization. Hence, is a potential alternative for vaginal agenesis.


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  1. Liao L-M, Doyle J, Crouch NS, et al. Dilation as treatment for vaginal agenesis and hypoplasia: a pilot exploration of benefits and barriers as perceived by patients. Job Stet Gynaecol 2006; 26(2):144–148. DOI: 10.1080/01443610500443527.
  2. Committee opinion: no. 562: müllerian agenesis: diagnosis, management, and treatment. Obstet Gynecol 2013;121(5):1134–1137. DOI: 10.1097/01.AOG.0000429659.93470.ed.
  3. McIndoe A. The treatment of congenital absence and obliterative conditions of the vagina. Br J Plast Surg 1950;2:254–267. PMID: 15410301.
  4. Blümel JE, Binfa L, Cataldo P, et al. Indice de función sexual femenina: un test para evaluar la sexualidad de la mujer. Rev Chil Obstet Ginecol 2004;69(2):118–125. DOI: 10.4067/S0717-75262004000200006.
  5. Fedele L, Frontino G, Restelli E, et al. Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome. Am J Obstet Gynecol 2010;202(1):33.e1–33.e6. DOI: 10.1016/j.ajog.2009.08.035.
  6. van der Sluis WB, Pavan N, Liguori G, et al. Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes. BJU Int 2018;121(6):952–958. DOI: 10.1111/bju.14155.
  7. Yang B, Wang N, Zhang S, et al. Vaginal reconstruction with sigmoid colon in patients with congenital absence of vagina and menses retention: a report of treatment experience in 22 young women. Int Urogynecol J 2013;24(1):155–160. DOI: 10.1007/s00192-012-1799-7. E.
  8. Acien P, Acién M, Oliva–Meyer MA, et al. McIndoe operation without skin graft: a new neovaginal prosthesis of Polylactic Acid (PLA). Brit J Med Med Res 2016;18(9):1–7. DOI: 10.9734/BJMMR/2016/29512.
  9. Acién P, Sánchez-Lozano M, Oliva MA, et al. A new model of prosthesis designed as mold to perform neovagina in patients with vaginal agenesis, Paper presented at: 2nd international meeting on MRKH syndrome. Poland: Varsav; 2016.
  10. Creatsas G, Deligeoroglou E, Christopoulos P. Creation of a neovagina after Creatsas modification of Williams vaginoplasty for the treatment of 200 patients with Mayer–Rokitansky–Kuster–Hauser syndrome. Fertil Steril 2010;94(5):1848–1852. DOI: 10.1016/j.fertnstert.2009.09.064.
  11. Moon HS, Koo J, Lee H, et al. Simple neovaginoplasty using spontaneous regeneration ability of labial and vestibular flap in patients with Müllerian agenesis. Gynecol Minim Invasive Ther 2017;6(4):173–177. DOI: 10.1016/j.gmit.2017.06.004.
  12. Schätz T, Huber J, Wenzl R. Creation of a neovagina according to Wharton–Sheares–George in patients with Mayer–Rokitansky–Küster–Hauser syndrome. Fertil Steril 2005;83(2):437–441. DOI: 10.1016/j.fertnstert.2004.06.079.
  13. Walch K, Kowarik E, Leithner K, et al. Functional and anatomic results after creation of a neovagina according to Wharton–Sheares–George in patients with Mayer–Rokitansky–Küster–Hauser syndrome-long-term follow-up. Fertil Steril 2011;96(2):492.e1–497.e1. DOI: 10.1016/j.fertnstert.2011.06.004.
  14. Saylor L, Bernard S, Vinaja X, et al. Anatomy of genital reaffirmation surgery (male-to-female): Vaginoplasty using penile skin graft with scrotal flaps. Clin Anat 2018;31(2):140–144. DOI: 10.1002/ca.23015.
  15. Wei SY, Li FY, Li Q, et al. Autologous buccal micro-mucosa free graft combined with posterior scrotal flap transfer for vaginoplasty in male-to-female transsexuals: a pilot study. Aesthet Plast Surg 2018;42(1):188–196. DOI: 10.1007/s00266-017-0977-x.
  16. Dhall K. Amnion graft for treatment of congenital absence of the vagina. Br J Obstet Gynaecol 1984;91(3):279–282. DOI: 10.1111/j.1471-0528.1984.tb04768.x.
  17. Garcia J, Jones HW. The split thickness graft technic for vaginal agenesis. Obstet Gynecol 1977;49(3):328–332. DOI: 10.1016/0007-1226(95)90104-3.
  18. Klingele CJ, Gebhart JB, Croak AJ, et al. McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life. Am J Obstet Gynecol 2003;189(6):1569–1573. DOI: 10.1016/s0002-9378(03)00938-4.
  19. Dasgupta S, Mukhopadhyay P, Sharma PP, et al. Mayer–Rokitansky–Kuster–Hauser type-B anomaly with MURCS association and gonadal dysgenesis. Journal of Obstet. Gynaecol. 2012;62(Suppl. 1):83–84. DOI: 10.1007/s13224-013- 0384-4.
  20. Oppelt P, Renner SP, Kellermann A, et al. Clinical aspects of Mayer–Rokitansky– Kuester–Hauser syndrome: recommendations for clinical diagnosis and staging. HumReprod 2006;21(3):792–797. DOI: 10.1093/humrep/dei381.
  21. Rock J. (2015). Surgery for Anomalies of the Mullerian Ducts.(HW Jonesa and J. Rock, Eds. 11th edition.) Te Lindes Opereative Gynaecology. Philadelphia. Wolters Kluwer. pp. 505–554.
  22. Jackson ND, Rosenblatt PL. Use of Interceed absorbable adhesion barrier for vaginoplasty. Obstet Gynecol 1994;84(6):1048–1050. PMID: 7970464.
  23. Motoyama S, Laoag–Fernandez JB, Mochizuki S, et al. Vaginoplasty with Interceed absorbable adhesion barrier for complete squamous epithelialization in vaginal genesis Am J Obstet Gynecol 2003;188(5):1260–1264. DOI: 10.1067/mob.2003.317.
  24. Anagani M, Agrawal P, Meka K, et al. Novel minimally invasive technique of neovaginoplasty using an absorbable adhesion barrier J Minim Invasive Gynecol 2020;27(1):206–211. DOI: 10.1016/j.jmig.2019.02.025.
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