The Study Of Laparoscopic Vaginoplasty With Single Piece Of Peritoneum

Objective: Congenital absence of vagina is caused by the rudimentary or failure to thrive of the bilateral paramesonephric duct. Clinical examination showed: absence of the vagina, uterus or rudimentary uterus, and ovaries normal, also can be associated with kidney, bone, hearing, heart or fingers in the abnormal. According to the literature, the incidence rate is 1 / 4000 ~ 1 / 5000 [1]. Surgery is the main treatment of the disease. Surgical field of laparoscopic assisted vaginal plasty is exposed to be more spacious than the traditional surgery, with less injury and less postoperative adhesions. The minor abdominal incision is congruent rith the privacy and mental demands of the patients. More and more experts of gynecology combines the traditional vaginoplasty with the laparoscopy. This creates a hollow which is closer to normal vaginal in the anatomy and function. The objective of this research is to investigate the prognosis, the key operating procedure and the skills of laparoscopic vaginoplasty with single piece of peritoneum by retrospective analysis of the 23 cases that is treatet in our hospital from December 2004 to December 2009.Methods: The 23 cases that is treatet by laparoscopic vaginoplasty with single piece of peritoneum in our hospital from December 2004 to December 2009 were selected as the reasearch group. The average age of patients is 21 (18 to 25 years old). Two of them got married and the others were single. All patients had the symptoms of primary amenorrhea. The preoperative examination of all cases showed female, normal breast, vulvae and vestibule of vagina, but no vaginalorifice and vacancy in pelvic by the rectal examination. Pelvic ultrasound examination showed normal ovarian, traces of uterine and no kidney and ureter malformation in these cases. The generalanesthesia and the lithotomy position are taken in the operation. Separat the peritoneum from the urinary bladder in laparoscopy. Make the hollow of the new vagina: separate the urethra, bladder and rectum clearance from the end of vestibule of vagina to the pelvic cavity. A new hollw is accomplished. Then extruding the separated peritoneum out of the new man-made hollow, surrounding the mold, stitching by 0/3 absorbable suture and putting it back. In the end we establish the pneumoperitoneum, stitch the peritoneum by 0/2 absorbable suture in laparoscopy, irrgate the pelvic cavity and check there's no haemorrhagia. Register the time of operation, the blood loss and the postoperative recovery.Results: The glass models of the vagina were successfully placed in the 23 patients by the operation. The average operating time was 107±20min (range 85 ~ 160 min) and the blood loss was 56±34ml (range 10 ~ 100ml). The time of exhaust was 2 days (range 1 to 3 days). The Foley was stopped after 3 to 5 days. After 2 months the postoperative examination showed: vaginal depth was up to 8 ~ 10cm; vaginal mucosa was ruddy, shiny, soft and flexible. Followed up for 3 months to 5 years: 4 cases of unmarried are still expanding vaginal mold; 16 cases of married discontinued the mold after marriage and have a satisfied sex. However, one of them has a complain of vaginal shortening; 2 patients were lost.Conclusion: The laparoscopic vaginoplasty with single piece of peritoneum is safer, faster and less invasive. The value of it avoids the laparotomy and acquires the best effect in function and figure.