Comparison of laparoscopic peritoneal vaginoplasty and sigmoid colon vaginoplasty performed during radical surgery for primary vaginal carcinoma

BACKGROUND Radical surgery of primary vaginal carcinoma typically involves partial or complete resection of the vagina, and young patients in particular can experience sexual dysfunction after surgery. Vaginoplasty is mandatory for this population, multiple vaginal reconstructive techniques have been reported. Here we attempted to determine whether the peritoneum is a feasible alternative to the sigmoid colon in vaginoplasty performed during radical surgery. METHODS Between February 2005 and July 2009, 12 patients underwent radical surgery for Federation of International Gynecology and Obstetrics Stage I primary vaginal carcinoma in the upper one-third of the vagina. To retain a sex life, the patients received vaginoplasty either with the peritoneum (peritoneal group, 5 patients) or with the sigmoid colon (sigmoid group, 7 patients) during radical surgery. Surgeries were performed at the Anhui Provincial Hospital in China. The data between the two groups was retrospectively analyzed. RESULTS The operating time was shorter for the peritoneal group than for the sigmoid group (P<0.05). There were no significant differences in blood loss as well as in the length or width of the neo-vaginas between the two groups during surgery (P>0.05). No metastasis or operation-related complications were observed in any of the patients. Six months after surgery, the neo-vaginas of both groups were smooth, soft, and moist. The neo-vaginas in the sigmoid group were similar in size during and 6 months after surgery. The neo-vaginas in the peritoneal group were shorter (although no less wide) 6 months after surgery (P<0.05); length and width (that admitted two fingers) remained stable thereafter. All patients experienced a satisfactory sex life after surgery. Colposcopy revealed a good vaginal surface covered with squamous epithelium in the neo-vaginas of the peritoneal group, and intestinalization in the neo-vaginas of the sigmoid group. At the 36-month follow-up, all patients were clinically free of disease. CONCLUSIONS Laparoscopic vaginoplasty using the peritoneum compared with using the sigmoid colon is simpler and more feasible for management of Stage I primary vaginal carcinoma. Its benefits include shorter operating time, no bowel disturbance, and production of a hygienic vaginal environment, as well as a potential sex life and oncologic outcome comparable to that of sigmoid colon vaginoplasty.