ABSTRACT INTERNAL - AGES

10ABSTRACTS continuedTHURSDAY 20 NOVEMBER 2008Further septum resection is not recommended. A completeseptum involves the cervix. Some surgeons believe thatresection of the cervical portion is associated with cervicalincompetence. However, leaving the cervical portion of theseptum might cause dystocia preventing vaginal delivery.Our practice is to resect the cervical septum.References:1. Atlas of Laparoscopy and Hysteroscopy Technique, 3rdedition (Ed. T. Tulandi), Informa, London, 2007.2. Homer HA, Li TC, Cooke ID. The septate uterus: areview of management and reproductive outcome.Fertil Steril 2000;73(1):1-143. Pabuccu R, Gomel V. Reproductive outcome afterhysteroscopic metroplasty in women with septateuterus and otherwise unexplained infertility. Fertil Steril2004;81(6):1675-8Author Affiliation: Togas Tulandi MD, MHCM. Professor ofObstetrics and Gynecology & Milton Leong Chair inReproductive Medicine McGill University, Montreal,Quebec, Canada.LAPAROSCOPIC CREATION OF NEO-VAGINATHE VECCHIETTI PROCEDUREThursday 20 November / Session 2 / 1150-1210Cooper MMayer-Von Rokitansky-Kuster-Hauser (MRKH) Syndromeis a rare congenital abnormality characterised by normalsecondary sexual characteristics, vaginal aplasia, normalovaries and a rudimentary uterus. The prevalence of thisanomaly is one case per 4-5,000 live female births. Toproduce a functioning neovagina in affected subjects,management relies on one of several approaches; nonsurgicali.e. Frank technique (1), a split-thickness skingraft i.e. McIndoes technique (2), sigmoid colon grafts(3,4) or a combination of surgical and non-surgical(Vecchietti technique). Numerous variations of thesetechniques have also been described.Giuseppe Vecchietti first described his technique forcreating a neovagina in subjects with Mayer-VonRokitansky-Kuster-Hauser Syndrome (MRKH) in 1965 (5).The initial description was of an open abdominalprocedure involving a Pfannenstiel incision, dissection ofthe vesico-rectal space and placement transabdominallyof two sutures passing from the anterior abdominal wallthrough the vaginal groove and into an external 'dilationolive'. Post-operatively the 'olive' is progressively drawninto the vaginal groove by continuous and increasingtension on the abdominal sutures wound. A neovagina isthus formed and is maintained patent by subsequentdilator use. This procedure has been used for subjectswith vaginal aplasia secondary to Mayer-Von Rokitansky-Kuster-Hauser and Morris syndrome (6) but also insubjects with a shortened vagina secondary to surgery orradiotherapy (7). The open procedure has been seen to behighly effective in producing an anatomical and functionalneovagina in more than 600 cases. The laparoscopicapproach was first described in 1992 (8,9) and has beenshown to have similar outcomes to the open procedure(10). Vecchietti procedures have been predominantlyperformed in Europe with only one case being reported inthe Australasian literature to date (11).The authors experience will be described during thepresentation.References:1. Frank, R. T. The formation of an artificial vagina withoutoperation. Amer. J Obst Gynec 1938; 35: 1053.2. McIndoe, A. The treatment of congenital absence andobliterative conditions of the vagina. Brit J Plast Surg1950; 2: 254.3. Wesley, J. R. and Coran, A. G.: Intestinal vaginoplasty forcongenital absence of the vagina. J Ped Surg 1992;27: 885.4. Hendren, W. H. and Atala, A.: Use of bowel for vaginalreconstruction. J Urol 1994; 152: 752.5. Vecchietti G. [Creation of an artificial vagina inRokitansky-Kuster-Hauser syndrome]. Attual OstetricGinecol. 1965; 11(2): 131-47, Mar-Apr.6. Marzetti L. Veneziano M. Boni T. Pecorini F. Framarinodei Malatesta MF. Giobbe M. Fabiani C. [The creationof a neovagina with laparoscopic technique]. ChirurgItal 1999; 51(3): 253-8.7. Veronikis DK. McClure GB. Nichols DH. The Vecchiettioperation for constructing a neovagina: indications,instrumentation, and techniques. Obstet Gynecol 1997;90(2): 301-4.8. Gauwerky JF. Wallwiener D. Bastert G. Anendoscopically assisted technique for construction ofa neovagina. Arch Gynecol Obstet 1992; 252(2): 59-63.9. Popp LW. Ghirardini G. Creation of a neovagina bypelviscopy. J Laparoendosc Surg 1992; 2(3): 165-73.10. Borruto F. Chasen ST. Chervenak FA. Fedele L. TheVecchietti procedure for surgical treatment of vaginalagenesis: comparison of laparoscopy and laparotomy.Intl J Gynaecol Obstet 1999; 64(2): 153-8.11. Cooper MJ. Fleming S. Murray J. Laparoscopicassisted Vecchietti procedure for the creation of aOvum II by Ana Duncan