MODIFIED MCINDOE TECHNIQUE–NOVEL MODALITY IN TREATMENT OF VAGINAL AGENESIS IN YOUNG WOMEN

Dr.S.Savitri; Dr.M.Manjulabai; Dr.P.S.Raja ravi Kumar

Volume : V, Issue : IV, April - 2015

MODIFIED MCINDOE TECHNIQUE–NOVEL MODALITY IN TREATMENT OF VAGINAL AGENESIS IN YOUNG WOMEN

Dr. S. Savitri, Dr. M. Manjulabai, Dr. P. S. Raja Ravi Kumar

Abstract :

 Incidence of vaginal agenesis varies from 4000 to 5000 live female births. Developmental anomalies of the Mullerian duct system is the major cause. This anomaly is also known as Mullerian aplasia. It can be complete or partial. Complete Mullerian aplasia ( MRKH – Mayer Rokitonsky Kustner Hauser syndrome ) – along with congenital absence of uterus & cervix Partial Mullerian aplasia is less common – presence of uterus & blind vaginal pouch. Tubes & ovries may be normal ( normal endocrine function) in all the cases Creating a neovagina in these cases so as to mimic normal vagina in terms of Size, lining & appearance is a challenge. Though multiple techniques have been designed , Modified McIndoe vaginoplasty represents the simplest one with good results. REVIEW OF LITERATURE Congenital vaginal agenesis is a rare malformation that has an incidence of one in 4000 to 5000 female newborns 1. Although vaginal agenesis is most commonly encountered in women with Rokitansky syndrome (Mayer–Rokitansky– Kuster Hauser syndrome or Mullerian aplasia)2 and Androgen insensitivity syndrome (AIS). It can also present in patients with Turner syndrome, Morris syndrome and as a part of combined congenital defects. Patients with Rokitansky syndrome and AIS have normal secondary sexual characteristics and external genitalia. These patients present with primary amenorrhea typically in adolescence. A blind or absent vagina is discovered during gynaecological examination in such patients. The purpose of the treatment is not only to create an adequate passage way for penetration but also to facilitate satisfactory sexual intercourse. There are several nonsurgical and surgical treatment techniques described in the literature for treatment of vaginal agenesis. Nonsurgical options include vaginal dilation with a dilator, while surgical options include the Vecchietti procedure3–5 , Davydov technique6, Mclndoe technique7 and intestinal vaginoplasty. The first vaginal reconstruction was performed by Amussat in 18328 .In 1872, Heppner was the first surgeon who used split thickness skin grafting for vaginoplasty9. Baldwin used a vascularised segment of ileum to create a new vaginal canal in 1908, while Wagner used sigmoid colon for the same purpose in 1927 10 The Mclndoe technique was first described in 1938 by Bainster and Mclndoe9. Despite the existence of several alternative methods, there is still no consensus regarding the best option for surgical correction  