ORIGINAL ARTICLE Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients Emilio Imparato & Alessandro Alfei & Giovanni Aspesi & Anton Livio Meus & Arsenio Spinillo Received: 4 December 2006 / Accepted: 8 March 2007 / Published online: 21 March 2007 # International Urogynecology Journal 2007 Abstract We performed a historical cohort study of 62 consecutive patients who underwent abdomino-perineal vaginal re-construction with a segment of the sigmoid colon during a 25-year period. A dedicated database was reviewed for the aetiology of vaginal malformation, surgical compli- cations and post-operative follow-up. Follow-up visits were scheduled 2, 6 and 12 months after discharge from hospital and annually thereafter. Fifty-eight (93.5%) patients were diagnosed as having Mayer–Rokitansky–Kuster–Hauser syndrome (MRKHS) and four (6.5%) had undergone previous demolitive surgery for gynaecologic malignancy. The mean operating time was 145 min (range 95 to 250 min). The mean hospital stay was 8.3 days (range 5 to 23 days). Post-operative complications requiring additional surgery occurred in 3 (4.8%) patients and were a case of necrotising fascitiis with leakage of the bowel anastomosis, a case of bowel occlusion and a case of neovaginal prolapse. The mean follow-up was 11.3 years (range 3 months to 24 years). We recorded 5 cases (8.1%) of sigmoid graft shrinkage treated successfully by dilation. The time interval between sigmoid vaginoplasty and first intercourse was 4 months (range 2 months to 4 years). During the follow-up, 32 (51.6%) women reported regular and 30 (48.4%) women reported occasional sexual intercourse; 80.6% (50/62) were “satisfied” with the surgical procedure. In this large series, laparotomic sigmoid vaginoplasty was a safe and acceptable technique to treat congenital absence of the vagina. This procedure allowed early sexual intercourse and was associ- ated with a low incidence of shrinkage and a high rate of patients’ satisfaction. Keywords Sigmoid vaginoplasty . Neovagina . Maier–Rokitansky–Kuster–Houser syndrome Introduction Vaginal re-construction may be indicated for the congenital absence of the vagina, after a pelvic exenterative procedure for pelvic malignancy or for an inter-sex condition [1, 2]. The Mayer – Rokitansky – Kuster – Hauser syndrome (MRKHS) is a rare congenital cause of primary amenor- rhoea due to uterovaginal agenesis. The incidence of this syndrome ranges from 1 in 4,000 to 1 in 10,000 births. Because of amenorrhoea and problems with intercourse, the diagnosis is often made during adolescence [1, 2]. The abrupt diagnosis of MRKHS in adolescent years, when the self-image is formed, has a considerable impact on a young woman’ s emotional stability [3]. In this period, anomalies of sexual organs may lead to profound identity problems, to a disturbed body image and to a low self- esteem due to the inability to conceive [3, 4]. In these patients, vaginal re-construction has positive effects on sexual activity, self-esteem and body image thus improving the overall quality of life [4, 5]. Numerous surgical and non-surgical methods have been proposed to create a Int Urogynecol J (2007) 18:1465–1469 DOI 10.1007/s00192-007-0358-0 E. Imparato : A. Alfei : A. Spinillo (*) Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, Università di Pavia, Piazzale Golgi, 27, 27100 Pavia, Italy e-mail: spinillo@smatteo.pv.it G. Aspesi Divisione di Ostetricia e Ginecologia, Ospedale Civile, Voghera, Italy A. L. Meus Struttura di Ostetricia e Ginecologia, Ospedali Galliera, Genova, Italy