Treatment of vaginal agenesis with modified Abbe-McIndoe technique: long-term follow-up in 22 patients

 Literature Review Article

Treatment of vaginal agenesis with modified Abbe-McIndoe technique: long-term follow-up in 22 patients. A.Keser, N.Bozkurt, Ö.Taner, Ö.Şensöz. European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 121, Issue 1, Pages 110-116 

Review
Obehi A. Asemota, M.D.
 

The purpose of this paper is to present the long term results of 22 patients with a follow-up period ranging between seven and fourteen years who had undergone the modified Abbe-McIndoe technique for treatment of vaginal agenesis. Findings of the 22 follow-up patients revealed vaginal depth of 6-10cm in 20 patients (mean 8cm) and 3cm in two patients.  Careful history of the two patients with insufficient vaginal depth reveled short-term (one month) and incorrect usage of the mould.

 The authors state that there were no complications in the patients studied such as seroma, hematoma, or infection in their series.  The authors further state that although other numerous surgical methods for the treatment of vaginal agenesis have been described, such as use of other tissue – (ileum, cecum, ileocecal segment) or the Veccihetti technique. The main disadvantages of these procedures are that they are complicated operative procedures requiring long operative time and presenting postoperative complications such as bleeding, prolapse and peritonitis.

They conclude that although other methods have been described since the first surgical intervention of the correction of vaginal agenesis, the inlay skin grafting technique proposed by McIndoe, the modified Abbe-McIndoe technique, is still the most effective and preferred one.

Comments
Steven R. Lindheim, M.D.
Meike L. Uhler, M.D.
 

This article addresses the management of congenital absence of the uterus and vagina.  The options for treatment include:

  • Modified Abbe-McIndoe technique:
     
    o Most commonly performed surgical technique which involves harvesting a meshed split-thickness skin graft from the patient's buttocks and placing it over a vaginal mold.
     
  • Laparoscopic approaches:
     
    o Davydov vaginoplasty involves placing an approximately 10-cm segment of bowel that can be mobilized but retain an adequate vascular pedicle to reach the perineum without traction on the pedicle or graft.
     
    o Vecchietti procedure involves placement of an acrylic 2-cm olive-shaped bead onto the vaginal dimple, which is gradually pulled superiorly by threads laparoscopically placed that are then connected to the traction device placed on the patient's abdomen. The threads are then gradually tightened approximately 1.0 to 1.5 cm/day for a week.
     
  • Non-operative approaches:
     
    o Progressive dilation, which places enough pressure to invaginate the tissues.

    o  Ingram modification of dilation, which involves sitting on a bicycle seat stool.                              

Using the Modified Abbe-McIndoe technique, Keser et al. followed the patients’ long term results with few postoperative complications and excellent results in vaginal depth.  This group of patients can be reassured that available treatment options will result in satisfactory quality of life.

*See also, the review of Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). C. Fotopoulou, J. Sehouli, N. Gehrmann, I. Schoenborn and W. Lichtenegger. Fertility and Sterility. 2010; 94:217-322.

The above review and commentary on this article were written by SRS Members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

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