Korean J Obstet Gynecol KJOG Korean Journal of Obstetrics & Gynecology 2233-5188 2233-5196 Korean Society of Obstetrics and Gynecology 10.5468/KJOG.2012.55.3.148 Original Article Results of laparoscopic davydov technique in 47 patients with congenital absence of the vagina: laparoscopic peritoneal vaginoplasty Park Ki-Hyun MD 1 2 Park Joo-Hyun MD 1 Yang Hyo-In MD 1 Choi Bo Ram MD 1 Baek Jeong Hye MD 1 Hong Yeon MD 1 Cho SiHyun MD 1 Seo Seok Kyo MD 1 Choi Young Sik MD 1 Lee Byung Seok MD 1 Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. Department of Obstetrics and Gynecology, SAM Ahnayang Hospital, Ahnayang, Korea. Corresponding author: Byung Seok Lee, MD. Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2019-3430, Fax: +82-2019-8209, dr222@yuhs.ac 03 2012 15 03 2012 55 3 148 157 20 02 2012 02 03 2012 Copyright © 2012. Korean Society of Obstetrics and Gynecology 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 Objective

To evaluate the technical feasibility and anatomical and functional outcomes of laparoscopic Davydov technique (transvestibular vaginoplasty with pelvic peritoneum) for the patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.

 Methods

This study was a retrospective review of prospectively collected data of 47 women with MRKH syndrome between 2005 and 2011. Clinical examination, pelvic ultrasound, intravenous urography and/or renal ultrasound, laparoscopy, karyotyping, orthopedics and ears, nose, and throat examination, magnetic resonance imaging was performed and 47 patients with MRKH syndrome underwent surgery with the procedure. Their clinical, surgical, and follow-up data were recorded and the functional outcome was assessed by a brief and valid self-report questionnaire evaluating female sexual life (Female Sexual Function Index, FSFI). A control group was recruited to compare the results.

 Results

The mean operative time was 117.2 ± 35.3 minutes. Two intra-operative rectal and one bladder injury were repaired without sequels. One patients had vault granulation at the neovagina, which healed after electric cautery and one patient had mild enterocele. The mean length of the neovagina was 8.3 ± 1.1 cm (range, 6 to 11 cm) without any shrinkage at the follow-up of 18.9 months (range, 6 to 53 months) after operation. The neovaginal introitus admitted two fingers in width in all patients. There was no statistical difference in the total FSFI between the case and control groups.

 Conclusion

Laparoscopic Davydov is a safe, effective treatment of MRKH syndrome with minimal invasion and a relatively low complication rate. The procedure has satisfactory anatomical and functional results. This technique offers advantages such as: short operating time and hospital stay, no particular instrumentation required and no external scars. Sexuality approaches so-called 'normal sexuality.'

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Operative procedure. (A) The edge of pelvic peritoneum reached the mucosa of the introitus, to which were sutured (B), (C). The top of the reconsructed vagina was formed by a purstring sutures, (D) mold was inserted into the vagina.

Vaginal dilator.

Appearance of the vaginal valut after Schiller test at 12 months.

Patients characteristics (n = 47)

Values are presented as mean ± standard deviation and range.

Clinical and anatomic outcomes of the 47 patients who underwent laparoscopic neovaginoplasty using peritoneum

Values are presented as mean ± standard deviation and range.

Female Sexual Function Index of the patients and controls

Values are presented as mean ± standard deviation.