UNFAVORABLE LONG-TERM RESULTS OF RECTOSIGMOID NEOCOLPOPOIESIS

We report on unfavorable long-term results after rectosigmoid neocolpo poiesis in 12 patients, as well as on possible prevention and treatmen t of these results. To prevent neovaginal introitus stenosis, the rect osigmoid mucosa should be sutured to the perineal skin in an exaggerat ed interdigital fashion. In cases where introitus stenosis has develop ed, pedicled transposition flaps from perineum or labia or from the gl uteal or inguinal plica region have to be used. Similar flaps also may be applied in cases of rectovagina fistulas. Neuromas at the mucosa-p erineal junction often are resistant to therapy. So-called diversion c olitis may be manifested by mucous discharge, mucosal bleeding, or dis comfort. This disorder may be treated successfully by local applicatio n of a solution containing short-chain fatty acids. Loperamidehydrocbl oride (Imodium) administered half an hour before intravaginal penetrat ion may be helpful to weaken or even prevent neovaginal contractions. Because of the possible higher risk of neovaginal adenocarcinoma, long -term followup of these patients is indicated.