The use of isolated caecal bowel segment in complicated vaginal reconstruction.

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 often results in vaginal obstruction and fistula formation. PATIENTS AND METHODS: The vagina was reconstructed using a 15-cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstructions; four of these had undergone previous fistula formation. Fourteen patients were followed for a mean of 3.6 (1-9) years. The surgical outcome was evaluated using a questionnaire completed by the patients.
RESULTS: The postoperative course was unremarkable in all patients. Four patients developed an introital stenosis requiring surgical intervention. Two patients were minors at the time of follow-up, while all the others had had sexual intercourse and reported that they were very satisfied with the functional 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.