Surgical Techniques for the Prolapse of Neovagina in Women: Case Report and Review of Literature

Figures & data

Figure 1 Intraoperative site during first surgery. The neovagina is attached to the promontory with PDS 2/0 sutures. After extensive dissection of adhesions there is no peritoneal coating present.

Figure 2 Initial intraoperative site during second surgery. The neovagina is hardly visible as it lays at the level of the pelvic floor and the former attachment to the promontory is detached completely.

Figure 3 (A) During the second surgery a single mesh strip was placed over the apex of the neovagina. It was not possible to dissect the anterior compartment down to level of the bladder neck and at the posterior wall the vascular pedicle had to be spared. (B) The sketch illustrates schematically the course of the mesh and the relation of the vascular pedicle.

Figure 4 Vascular pedicle. Anteriorly the neovagina is visible. The strand deriving from the posterior wall corresponds to the vascular pedicle.

Table 1 Synopsis of surgical techniques for prolapse repair in the reported cases from the literature review

Case	Author	Year	Technique of Neovagina	Technique for Primary Repair	Recurrence (Y/N)	Technique for Repair of Recurrence	Adverse Events	Comment	Ref
1	Freundt	1994	Sigmoid colon	8	N				[^Citation6]
2	Freundt	1995	Sigmoid colon	8	Y	6			[^Citation6]
3	Freundt	1996	Sigmoid colon	2, 8, 12	Y	8, 12		Bilateral fixation to levator fascia	[^Citation6]
4	Matsui	1999	Sigmoid colon	6	N				[^Citation7]
5	Peyromaure	2000	Sigmoid colon	1	N				[^Citation8]
6	Schaffer	2002	Dilatation	6, 7, 9	N				[^Citation15]
7	Schaffer	2002	McIndoe	6, 7, 8	N				[^Citation15]
8	Yokomizo	2002	Sigmoid colon	12	Y	2		Fascia strips	[^Citation9]
9	Yokomizo	2002	Sigmoid colon	12	N		Infected hematoma	Resection, new neovagina with fasciocutaneous flap	[^Citation9]
10	Coulon	2005	Labia minora	3	N				[^Citation16]
11	Delotte	2009	Ileocecal	4	N				[^Citation17]
12	Calcagno	2010	Dilatation	1	N				[^Citation18]
13	Christopoulos	2011	Dilatation	4	N				[^Citation19]
14	Kondo	2012	Sigmoid colon	4	N				[^Citation10]
15	Zhu	2013	Sigmoid colon	1	N				[^Citation11]
16	Swenson	2014	Sigmoid colon	1	N				[^Citation12]
17	Huffman	2014	VRAM flap	10	N				[^Citation20]
18	Huffman	2014	VRAM flap	10, 11	N				[^Citation20]
19	Toidze	2015	Dilatation	3, 5	Y	4	Mesh erosion		[^Citation21]
20	Popov	2016	Sigmoid colon	4	N				[^Citation13]
21	Hao	2017	Sigmoid colon	1, 2	N				[^Citation14]
22	Botros	2017	Dilatation	1	N				[^Citation22]
23	Neron	2017	Omentoplasty	1	Y	12, 5			[^Citation23]

Notes: 1, sacrospinous ligament suspension; 2, resection abundant mucosa; 3, posterior vaginal mesh; 4, lsc sacrocolpopexy with mesh; 5, anterior vaginal mesh; 6, abd sacrocolpopexy with mesh; 7, Halban culdoplasty; 8, Cooper ligament suspension. 9, paravaginal repair; 10, colporrhaphy; 11, sacrocolpopexy without mesh’ 12, other.

Figure 5 Procedure of literature selection with corresponding numbers of publications.

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