Laparoscopically assisted uterovestibular anastomosis in patients with uterine cervix atresia and vaginal aplasia

Objective: To describe the surgical technique and the long-term anatomic and functional results of laparoscopically assisted uterovestibular anastomosis. Design: Descriptive study. Setting: Tertiary referral center. Patient(s): Twelve consecutive patients with uterine cervix atresia and vaginal aplasia. Intervention(s): Laparoscopically assisted uterovestibular anastomosis was performed in all patients. Follow-up assessments at 1, 6, and 12 months included pelvic examination, transvaginal ultrasonography, and, in selected cases, vaginoscopy and hysteroscopy. Subsequent follow up was done by referring physicians or by means of telephone interview. Mean follow-up was 6 years. Main Outcome Measure(s): Intra- and postoperative characteristics and anatomic and functional outcome. Result(s): The surgical procedure was successful in all cases and all of the women have experienced regular menstruation. At 6-month follow-up, mean vaginal length was 6 cm and at least 80% of neovaginal epithelium was iodine-positive in all patients. Six women were sexually active during follow-up without difficulty. None have yet attempted to seek a pregnancy. Conclusion(s): The study shows the safety and effectiveness of a laparoscopic approach to uterovestibular anastomosis in women with cervical atresia and vaginal aplasia. In these patients, we believe that conservative surgery should represent the first therapeutic option. A longer follow-up is needed to assess pregnancy rates and outcome.