Abstract
Introduction
The first-line approach for the management of distal vaginal atresia involves a pull-through vaginoplasty. If the proximal vagina is 3 cm or more from the introitus, the risk of stenosis is high, and an interposition graft may be necessary. We describe a safe, low-cost, and accessible approach for distal vaginal atresia ≥ 3 cm that we call the “modified balloon vaginoplasty” and validate the technical feasibility and anatomical outcomes.
Methods
Ten patients who underwent modified balloon vaginoplasty were retrospectively evaluated. Age, symptoms at presentation, length of atresia, operation time, and postoperative complications were analyzed.
Results
All the cases were successfully performed without any intraoperative morbidity. The postoperative complications included one case of stenosis ring in the distal vagina because not right used vagina model. All the girls had regular menstruation and were satisfied with the surgical outcome.
Conclusion
Modified balloon vaginoplasty allows further distention of the distal vagina or thinning of the septum, which may decrease the risk of stenosis, is a beneficial choice for patients with distal vaginal atresia ≥ 3 cm.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and materials
The datasets used during the current study are available from the corresponding author on reasonable request.
References
Debiec KE, Amies A-M, Oelschlager (2020) Uterovaginal anomalies: a guide for the generalist obstetrician-gynecologist. Clin Obstet Gynecol 63(3):512–527. https://doi.org/10.1097/GRF.0000000000000542
Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion Summary, Number 779 (2019) Obstet Gynecol 133(6): 1290–1291 doi: https://doi.org/10.1097/AOG.0000000000003282.
Mansouri R, Dietrich JE (2015) Postoperative course and complications after pull-through vaginoplasty for distal vaginal atresia. J Pediatr Adolesc Gynecol 28:433–436. https://doi.org/10.1016/j.jpag.2014.12.007
Skinner B, Quint EH (2017) Obstructive reproductive tract anomalies: a review of surgical management. J Minim Invasive Gynecol 24(6):901–908. https://doi.org/10.1016/j.jmig.2017.04.020
Committee on Adolescent Health Care. ACOG Committee Opinion No. 728: Müllerian agenesis: diagnosis, management, and treatment (2018) Obstet Gynecol 131(1): 35–42. doi: https://doi.org/10.1097/AOG.0000000000002458.
Zhang X, Tang X, Ding Y, Hua K (2020) Management of partial vaginal agenesis according to the Wharton-Sheares-George technique - a long-term follow-up. Obstet Gynaecol 40(5):715–717. https://doi.org/10.1080/01443615.2019.1655721
Karim RB, Hage JJ, Dekker JJ, Schoot CM (1995) Evolution of the methods of neovaginoplasty for vaginal aplasia. Eur J Obstet Gynecol Reprod Biol 58:19–27. https://doi.org/10.1016/0028-2243(94)01954-6
Xie Z, Zhang X, Zhang N, Xiao H, Liu Y, Liu J et al (2017) Clinical features and surgical procedures of congenital vaginal atresia-A retrospective study of 67 patients. Eur J Obstet Gynecol Reprod Biol 217:167–172. https://doi.org/10.1016/j.ejogrb.2017.08.016
van Bijsterveldt C, Willemsen W (2009) Treatment of patientswith a congenital transversal vaginal septum or a partial aplasia of the vagina. The vaginal pull-through versus the push-through technique. J Pediatr Adolesc Gynecol 22:157–161. https://doi.org/10.1016/j.jpag.2008.02.008
Zhang M, Zhang M-X, Li G-L, Cong-Jian Xu (2017) Congenital vaginal atresia: a report of 39 cases in a regional obstetrics and gynecology hospital. Hua zhong Univ Sci Technol Med Sci 37(6):928–932. https://doi.org/10.1007/s11596-017-1829-2
Ciftci I (2012) Laparoscopic-assisted perineal pull-through vaginoplasty. J Pediatr Surg 47(4):e13-15. https://doi.org/10.1016/j.jpedsurg.2011.11.070
Kisku S, Varghese L, Kekre A, Karl SSS, Mathai J, Thomas RJ, Kishore R (2015) Bowel vaginoplasty in children and young women: an institutional experience with 55 patients. Int Urogynecol J 26(10):1441–1448. https://doi.org/10.1007/s00192-015-2728-3
Lacy J, Correll GR, Walmer DK, Price TM (2007) Simple vaginal mold for use in the postoperative care of patients with a transverse vaginal septum. Fertil Steril 87(5):1225–1226. https://doi.org/10.1016/j.fertnstert.2006.11.013
Gundeti MS, Kumar R, Mohammad M (2021) Robotic assisted ileo-vaginoplasty for vaginal atresia. J Pediatr Urol 17(2):273–274. https://doi.org/10.1016/j.jpurol.2021.01.023
Zhang X, Qiu J, Ding Y, Sun Li, Hua K (2020) Single port laparoscopy combined with vaginal cervicovaginal reconstruction in a patient with congenital atresia of the cervix. Fertil Steril 113(3):681–682. https://doi.org/10.1016/j.fertnstert.2019.11.011
El Saman AM, Fathalla MMF, Zakherah MS, Shaaban OM, Nasr A (2009) Modified balloon vaginoplasty: the fastest way to create a natural neovagina: minor changes in technique eliminate the need for customized instruments. Am J Obstet Gynecol 201:546.e1–5. https://doi.org/10.1016/j.ajog.2009.09.018
El Saman AM, Zakherah MS, Nasr AM, Fathalla MM (2009) Distension versus traction in laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia. Int J Gynaecol Obstet 104:72–73. https://doi.org/10.1016/j.ijgo.2008.08.001
El Saman AM (2009) Combined retropubic balloon vaginoplasty and laparoscopic canalization: a novel blend of techniques provides a minimally invasive treatment for cervicovaginal aplasia. Am J Obstet Gynecol 201:333.e1–5. https://doi.org/10.1016/j.ajog.2009.07.001
El Saman AM (2010) Retropubic balloon vaginoplasty for management of Mayer–Rokitansky–Küster–Hauser syndrome. Fertil Steril 93:2016–2019. https://doi.org/10.1016/j.fertnstert.2008.12.046
El Saman AM, Ismael AM, Zakherah MS, Nasr A, Tawfik RM, Bedaiwy MA (2011) Enhancement balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Fertil Steril 95:779–782. https://doi.org/10.1016/j.fertnstert.2010.10.008
El Saman AM, Saad H, Hassanin AI, Shokery M, Abdelghaffar HM (2012) Inverted balloon vaginoplasty: an obstructed upper vaginal pouch was pulled downward to form a neovagina. Am J Obstet Gynecol 206(3):267.e1–4. https://doi.org/10.1016/j.ajog.2011.09.015
Acknowledgements
We thank the patient and their family for agreeing to share their experience to give guidance to others impacted by this rare condition.
Funding
The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Contributions
MZ contributed to the conception of the study, data analyses and wrote the manuscript. LM contributed to patient management. YD contributed to patient management. JZ contributed to data collecting. ZL contributed to data collecting. SL contributed to data collecting. XH contributed to the conception of the study, surgical implementation, patient management, and data analyses. We declare that all authors have read and approved the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Second Hospital of Hebei Medical University.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent to publication
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zhang, M., Meng, L., Du, Y. et al. Modified balloon vaginoplasty for high position vaginal atresia. Pediatr Surg Int 38, 631–635 (2022). https://doi.org/10.1007/s00383-022-05078-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-022-05078-2