Neovagina formation by expansion of the vaginal vault

Abstract

Aims: To present the technique, and its modifications, for the treatment of vaginal aplasia; to review the published data, focusing on the post-operative functional results; and to critically report potential advantages and limitations of the technique. Reviewed data: This chapter describes our optimized laparoscopically assisted neovaginoplasty technique and discusses data on other expansion-based techniques derived from the Vecchietti procedure. These techniques are minimally invasive, require no other tissues (skin, peritoneum, or intestine), and dispense with plastic surgery. In experienced hands, expansion-based procedures are fast, create an anatomically, histomorphologically, and functionally normal neovagina, and achieve satisfactory short and long-term results.Clinical implications: In terms of sexual satisfaction with minimal surgical intervention and maximum protection and conservation of female integrity, laparoscopically assisted neovaginoplasty via an abdominal traction device placed by means of vaginoabdominal perforation without vesicorectal tunneling may well in the future be considered the technique of choice. However, the technique requires specialist centers with the necessary experience and multidisciplinary expertise. Risks include injuries to the intestine, bladder, or rectum, bleeding, and hematoma formation.Open issues for further research: Prospective comparative trials are needed but difficult to conduct due to the low incidence of congenital vaginal aplasia.