How is Vaginal Function in Patients with A History of Sigmoid Vaginoplasty Surgery?

@#Introduction: Sigmoid colon vaginoplasty is a surgical procedure for the management of vaginal agenesis cases. This technique produces a neovagina that can function as a menstrual blood outlet as well as on penetration during sexual activity. Methods: A retrospective case study of vaginal agenesis, where sigmoid colon vaginoplasty surgery was performed at Dr. Sardjito Hospital Yogyakarta Indonesia in 2016-2018. The following post-surgical evaluation were assessed by observing the vaginal function to drain menstrual blood out, as well as function on penetration during sexual activity. Results: Sixteen cases of vaginal agenesis surgically performed were reported. Identification of the reproductive organs was carried out, in which 3 patients were without uterus, and 13 patients had menstrual uterine function. The length of sigmoid colon graft was around 15-20 cm. There were no complications during surgery. Post-surgical evaluation of 5 cases who have been married, all have been able to penetrate in sexual activity without meaningful complaints. All cases that had a uterus underwent regular menstrual cycles, with no dysmenorrhea. It can be said as a whole that this surgical procedure can be accepted by the patients, because it produced good vaginal function. Conclusions: Sigmoid colon vaginoplasty was a surgical procedure for congenital vaginal agenesis with satisfactory results. There were no complaints of dyspareunia or post-surgical dysmenorrhoea, resulting in a good cosmetic appearance of the external genitalia, and relatively mild complications.

Double Pedicle Artery Rotation Sigmoid Vaginoplasty for Vaginal Aplasia Management

Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.

Side-to-Side Ileosigmoidostomy Shunting Surgery for the Treatment of Elderly Patients With Chronic Constipation

Constipation is a digestive disorder that often occurs in the elderly; its main cause is bowel motility disorder. Treatments for patients with chronic constipation include pharmacotherapy, diet changes, and surgery if other therapies do not offer satisfactory results. We describe 4 patients, 2 men (70 and 65 years old) and 2 women (75 and 66 years old), who were diagnosed with chronic constipation (slow transit constipation) and treated with conventional therapy, but did not improve. For that reason, side-to-side ileosigmoidostomy shunting surgery was performed. After the surgery, the average time until normal defecation was 16 days, and the defecation frequency was 3 to 4 times a day with no need for a laxative. No patient had a recurrence of constipation. Based on these results, side-to-side ileosigmoidostomy shunting surgery is expected to restore digestive function and can be considered as an alternative therapy for elderly patients with chronic constipation.