A Simple Laparoscopic Procedure to Restore a Normal Vaginal Length After Colpohysterectomy With Large Upper Colpectomy for Cervical and/or Vaginal Neoplasia

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• 作者：Eric Leblanc ; MD^a ; ^{e-leblanc@o-lambret.fr" class="auth_mail" title="E-mail the corresponding author} ; Lucie Bresson ; MD^a ; Benjamin Merlot ; MD^a ; Marco Puga ; MD^a ; Frederic Kridelka ; MD ; PhD^b ; Audrey Tsunoda ; MD^c ; Fabrice Narducci ; MD^a
• 关键词：Colpohysterectomy ; Colpoplasty ; Davydov ; Laparoscopy ; Vaginoplasty
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：23
• 期：1
• 页码：120-125
• 全文大小：1032 K

文摘

Colpohysterectomy is sometimes associated with a large upper colpectomy resulting in a shortened vagina, potentially impacting sexual function. We report on a preliminary experience of a laparoscopic colpoplasty to restore a normal vaginal length. Patients with shortened vaginas after a laparoscopic colpohysterectomy were considered for a laparoscopic modified Davydov's procedure to create a new vaginal vault using the peritoneum of the rectum and bladder. From 2010 to 2014, 8 patients were offered this procedure, after informed preoperative consent. Indications were 2 extensive recurrent vaginal intraepithelial neoplasias grade 3 and 6 radical hysterectomies for cervical cancer. Mean vaginal length before surgery was 3.8 cm (standard deviation, 1.6). Median operative time was 50 minutes (range, 45–90). Blood loss was minimal (50–100 mL). No perioperative complications occurred. Median vaginal length at discharge was 11.3 cm (range, 9–13). Sexual intercourse could be resumed around 10 weeks after surgery. At a median follow-up of 33.8 months (range, 2.4–51.3), 6 patients remained sexually active but 2 had stopped. Although this experience is small, this laparoscopic modified Davydov's procedure seems to be an effective procedure, adaptable to each patient's anatomy. If the initial postoperative regular self-dilatation is carefully observed, vaginal patency is durably restored and enables normal sexual function.