https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/237 Tue, 04 Jul 2017 10:11:03 +0000 Abstract Background and objectives: Vaginoplasty is a procedure for the reconstruction of vaginal canal. Various surgical techniques have been described for vaginal reconstruction with variable success. The aim of this study was to assess the use of sigmoid colon in vaginal reconstruction of patients with disorders of sex development. Methods: Eleven patients were included in this study from January 2009 to December 2016. All patients underwent karyotyping, pelvi-abdominal ultrasonography, endocrine and psychiatric assessment. Sigmoid neo-vaginoplasty was the procedure chosen for all the cases. Surgical and functional outcomes were assessed post-operatively over a period of 6 month to 6 years. Results: The preoperative diagnosis included 9 cases of aplasia of the Mullerian ducts or Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), 1 androgen insensitivity syndrome (AIS) and 1 pseudohermaphrodite case. The mean age of the study population was 22.5 years (range 15-30 yrs). No intra-operative or early postoperative complications occurred. The mean vaginal length achieved was 13.0 cm (range 10.5 – 15 cm). Long term follow-up showed introital stenosis in 2 cases (17%) which resolved well to vaginal dilatation. One patient had pelvic abscess and treated by surgery. Sexual satisfaction was achieved in 10 cases, as 1 case was unmarried. Conclusion: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal reconstruction. It is a safe technique and provides the patient with a cosmetic neovagina of adequate caliber with satisfactory functional outcome. IMC J Med Sci 2018; 12(1): 27-31. DOI: https://doi.org/10.3329/imcjms.v12i1.35175 Address for Correspondence: Dr. Mohammed Rashedul Islam, Assistant Professor, Department of Plastic Surgery, BIRDEM General Hospital, Room No. 1119, 122 Kazi Nazrul Islam Avenue, Dhaka – 1000. Email: rashedplastic@gmail.com   Introduction Vaginoplasty is a procedure for the reconstruction of vaginal canal and the vulva that can be performed in various clinical situations. Though a rare procedure, the commonest indication is the congenital absence of the vagina, which occurs as a result of aplasia of the Mullerian ducts (46, XX) or Mayer-Rokitansky -Küster-Hauser syndrome (MRKH). Second indication is disorders of sex development (DSD). A large number of medical conditions involving the reproductive system fall under DSD, which is used as an umbrella term for these anomalies. The most common DSD is congenital adrenal hyperplasia (CAH) followed by androgen insensitivity syndrome (AIS, 46, XY) [1]. Genetic sexual ambiguity and vaginal loss resulting from gynecologic cancer or post traumatic injury are other two indications for neo-vaginoplasty [2]. The ovaries, given their separate embryologic source, are normal in structure and function. Reported incidences of congenital absence of the vagina vary from 1 in 4,000 to 5,000 female births [2,3]. The three basic tenets of vaginoplasty are: (a) creation of space between urethra and urinary bladder anteriorly anus and rectum posteriorly, (b) providing this space with a durable lining and (c) maintaining the dimensions and integrity of the newly created vagina. The advantages of using a bowel segment in contrast to other methods of vaginoplasty are: 1) no graft failure or secondary contracture/stenosis because a vascularized epithelial-lined tube is used, 2) patency and depth can be maintained without a mold and with minimal dilatation, 3) spontaneous mucus production matches that of the normal vagina and facilitates sexual intercourse, 4) dyspareunia, frequently seen with skin grafts, is avoided by the ability of the intestinal segment to withstand local trauma, 5) the use of an intestinal segment offers the option of performing a bowel interposition vaginoplasty during infancy at the time of surgical correction of more complex associated caudal anomalies and 6) avoids the disadvantage of sweating, maceration, hair growth and foul smell associated with skin flaps. The sigmoid colon is the best choice for interposition vaginoplasty because of size, location, and ease of preserving blood supply [8]. In this series, we evaluated the use of sigmoid colon for vaginal replacement among patients with MKRH and DSD.   Methods Study population and baseline investigations: The current study included 11 patients from January 2009 to December 2016. All were reared as females. Complete hormonal assessment was done. Sigmoid neo-vaginoplasty was the procedure chosen for all the cases. Surgical and functional outcomes were assessed postoperatively. All patients were subjected to history taking and physical examination. All patients underwent karyotyping, pelvi-abdominal ultrasonography, endocrine and psychiatric assessment. Informed written consent was obtained from all patients or their guardians. None of the patients underwent mechanical and/or antibiotic bowel preparation prior to surgery. 2026 Ibrahim Medical College. All rights reserved.