Objective To report a one-stage procedure, using a segment of caecum, both
to overcome failed previous procedures and for primary vaginal replacement
in patients with congenital vaginal aplasia, where primary reconstruction o
ften results in vaginal obstruction and fistula formation.
Patients and methods The vagina was reconstructed using a 15-cm isolated ca
ecal segment placed between the bladder and rectum and anastomosed to the i
ntroitus. Between 1985 and 1997 the technique was used in 17 patients (mean
age 23 years). Indications included congenital malformations and vaginal l
oss through anterior exenteration or trauma. Seven of the 17 patients had u
ndergone previous complex reconstructions; four of these had undergone prev
ious fistula formation. Fourteen patients were followed for a mean of 3.6 (
1-9) years. The surgical outcome was evaluated using a questionnaire comple
ted by the patients.
Results The postoperative course was unremarkable in all patients. Four pat
ients developed an introital stenosis requiring surgical intervention. Two
patients were miners at the time of follow-up, while all the others had had
sexual intercourse and reported that they were very satisfied with the fun
ctional and cosmetic result.
Conclusion In patients in whom previous vaginal reconstruction has failed,
the caecal segment should be used to create a neovagina. By considering the
patient's age, the surgeon can optimize the surgical result.