Methods and results
A 32-year-old woman came to our obstetrics and gynecology clinic for
evaluation and treatment of NP. She underwent transabdominal sigmoid
vaginoplasty 10 years previously in another hospital. Three months
later, she had satisfying sexual intercourse with her husband, and did
not perform vaginal dilation. Two years ago, she found a mass protruding
from vaginal introitus, aggravating when she was standing for a long
time or coughing and so on increased abdominal pressure. In addition,
she was troubled by the increasing foul-smelling vaginal discharge,
which seriously affected her daily life and sexual intercourse. The
patient requested surgical repair. Gynecologic examination showed
exstrophy of the vaginal apex 4 centimeters beyond the hymen (Figure
S1). Gynecological sonography prompted no uterus was detected, and no
obvious abnormality was found in urinary system examination. Pelvic
magnetic resonance revealed malformation of reproductive system, and
vaginal wall was slightly thickened.
After well informing the patients about the risks and benefits of using
a mesh and laparoscopic operations, and obtaining the informed consent
of the patient, we performed the laparoscopic sacro-colpopexy with a
mesh. Under the general anesthesia, the patient was placed in the
lithotomy position. During the operation, we recognized intestines were
compact adherent to the parietal peritoneum. After blunt and sharp
dissection, we observed the absence of uterus and right adnexa in pelvic
cavity. Using the uterine manipulator to explore the sigmoid
neovagina,
and the original bowel was located on the left of artificial vagina. For
the vascular pedicle locating on the posterior wall of vagina, we could
only completely separate the anterior wall. After carefully exploring
the anterior region of sacral vertebra, we opened the right
retroperitoneum from the sacral promontory, as well as dissected and
isolated the right ureter. The mesh was sutured at the anterior wall and
apex of neovagina (Figure 1), and then was suspended in the anterior
sacral region without blood vessels (Figure 2). Then peritoneum was
closed with interrupted suture with absorbable thread to posit the mesh
completely retroperitoneal (Figure 3). After surgery, we performed the
gynecological examination again, and there was no prolapse of neovagina
(Figure 4).
The operation lasted 195 minutes. The postoperative course was
uneventful without any mesh related complications. The patient was
discharged 6 days after surgery. One month after operation, the patient
returned for reexamine. No neovagina prolapse was detectable (Figure
S2), and the patient presented significant improvement of symptoms and
satisfied with sexual intercourse.