Laparoscopically Assisted Neovaginoplasty in Vaginal Agenesis: A Long-Term Outcome Study in 240 Patients

Study Objective: To assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis. Design: Combined retrospective and prospective study. Setting: University hospital. Participants: 240 patients with congenital vaginal agenesis. Interventions: Patients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device. Main Outcome Measures: Long-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections. Results: During median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intra-epithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up. Conclusions: Our technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.