Published: 2017-09-23

Surgical and functional outcome of sigmoid colon-vaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome

Pradyumna Pan


Background: The objective of this study is to report our experience with sigmoid vaginoplasty in adolescent female patients of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with emphasis on the effectiveness of surgery, complications, sexual and functional outcomes.

Methods: A retrospective study of adolescent females with vaginal atresia and Mayer-Rokitansky-Kuster-Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the case.

Results: Eleven females were studied over a period of 15 years. Postoperative complications were perineal rash in 3, ileus in 3, and minor wound infection in 1 patient and urinary tract infection in one patient. Nine patients were on regular follow-up. All the neovaginas were patent and functional. The postoperative mean vaginal length was 12.1 cm (range 11 cm to 14 cm). One of the patients had mild vaginal stenosis which responded to vaginal dilation, one had mucosal prolapse of the neovagina, one had excessive mucus discharge, during follow-up visits. Out of the 11patients, 8 patients are sexually active and 7 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Only one experienced dyspareunia and three patients had not participated in sexual activity.

Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not demanding prolonged dilatation and short recovery time.


Mayer-Rokitansky-Kuster-Hauser syndrome, Vaginal agenesis, Vaginal reconstruction

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Hendren WH, Atala A. Use of bowel for vaginal reconstruction. J Urol. 1994;152:752-5.

Hughes IA. Disorders of sex development: a new definition and classification. Best Pract. Res Clin Endocrinol Metab. 2008;22:119-34.

Leduc B, van Campenhout J, Simard R. Congenital absence of the vagina. Observations on 25 cases. Am J Obstet Gynecol. 1968;100:512 -20.

Folch M, Pigem I, Konje JC. Mullerian agenesis: etiology, diagnosis, and management. Obstet Gynecol Surv. 2000;55:644- 9.

Hensle TW, Chang DT. Vaginal reconstruction. Urol Clin North Am. 1999;26:39 -47.

Gupta NP, Ansari MS. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - a review. Indian J Urol. 2002;18:111-6.

ACOG Committee Opinion No. 355. Vaginal agenesis, diagnosis, management, and routine care. Obstet Gynecol. 2006;108:1605-9

De Souza AZ, Maluf M, Perin PM, Maluf Filho F, Perin LF. Surgical treatment of congenital uterovaginal agenesis: Mayer–Rokitansky–Kuster–Hauser syndrome. Int Surg.1987;72:45-7.

Mungadi IA, Ahmad Y, Yunusa GH, Agwu NP, Ismail S. Mayer-Rokitansky-Kuster-Hauser Syndrome: Surgical Managementof Two Cases. J Surg Tech Case Rep. 2010;2(1):39-43.

Rawat J, Ahmed I, Pandey A, Khan TR, Singh S, Wakhlu A, Kureel SN. Vaginal agenesis: Experience with sigmoid colon neovaginoplasty. J Indian Assoc Pediatr Surg. 2010;15(1):19-22.

Imparato E, Alfei A, Aspesi G, Meus AL, Spinillo A. Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(12):1465-9.

Kapoor R, Sharma DK, Singh KJ, Suri A, Singh P, Chaudhary H, Dubey D, Mandhani A. Sigmoid vaginoplasty: long-term results. Urology. 2006;67(6):1212-5.

Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases. J Sex Med. 2011;8(12):3487-94.

Nowier A, Esmat M, Hamza RT. Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development. Int. Braz j urol. 2012;38:380-6.

Hanna MK. Vaginal construction. Urology. 1987;29:272-5.

Parsons JK, Gearhart SL, Gearhart JP. Vaginal reconstruction utilizing sigmoid colon: Complications and long-term results. J Pediatr Surg. 2002;37:629-33

Khen-Dunlop N, Lortat-Jacob S, Thibaud E, Clément-Ziza M, Lyonnet S, Nihoul-Fekete C. Rokitansky syndrome: Clinical experience and results of sigmoid vaginoplasty in 23 young girls. J Urol. 2007;177:1107-11.

Froese DP, Haggitt RC, Friend WG. Ulcerative colitis in the auto transplanted neovagina. Gastroenterology.1991;100:1749-52.

Toolenaar TA, Freundt I, Huikeshoven FJ, Drogendijk AC, Jeekel H, Chadha AS. The occurrence of diversion colitis in patients with a sigmoid neovagina. Human Pathol 1993;24:846-9.

Fotopoulou C, Neumann U, Klapp C, Lichtenegger W, Sehouli J. Long-term effects of neovaginal reconstruction with sigmoid loop technique on sexual function and self-image in patients with gynecologic malignancies: results of a prospective study. Gynecol Oncol. 2008;111(3):400-6.

Bean EJ, Mazur T, and Robinson AD. Mayer-Rokitansky-Kuster-Hauser Syndrome: Sexuality, Psychological Effects, and Quality of Life. J Pediatr Adolesc Gynecol. (2009);22:339e346.