Complications : Intraoperative : Bladder injury - 3, Rectal injury – 1. All repaired in same sitting, no long term complications. Reproductive Outcome : Successfully reconstructed Utero – Cervico – Vaginal tract – 31 / 35 cases. No functional uterus, normal neo-vagina -rest 4 cases. Normal menses established - 31 /31 successful cases. Married-6, Infertility4, dyspereunia-nil. Pregnancy – 2 cases, one had 2 preterm Cesarean Sections for cervical factor, later hysterectomy at 28yrs age for DUB (inaccessible cervix, vagina); another case had spontaneous abortion at 10 weeks of pregnancy.
I.
Cervical Absence / Aplasia / Agenesis (17 Cases)
II.
Cervical Dysgenesis (14 Cases)
III. Cx Agenesis (Cervicoplasty/metroplasty not done – cavity minimal, poor prognosis) Cervical Stents used have ranged from Foley's catheter 3, Mallecot's catheter 18, Karman cannula 3, Cu-T 2, PCN cannula - 5 Vaginal mould / graft need to be used 7 : Split skin thickness graft with foam mould - 2, Amnion with glass mould - 6, Amnion with foam mould – 12, Surgicele with foam mould - 9
On follow-up (1yr - 13 years) : Repeat procedures - abdominoperineal Cervico-vaginoplasty- 4, ultrasound guided cervicovaginoplasty – 1, Hysterectomy – 1 case, Pyometra – 1 case. Premature menopause (chromosomal factor Turner Mosaic), has withdrawl bleeding to hormone replacement therapy – 1 girl. Hysterectomy - 1/ 31 successful cases; patient was from foreign country, first operated successfully, could not come for Cervical dilatation & follow-up – Cx stenosed. Repeat Cx-plasty, again Cx restenosed- requested hysterectomy, done. In conclusion, hysterectomy should not be done in cases of Cervical atresia with functioning uterus. Reconstructive surgery of cervical agenesis is a difficult but viable alternative. Coital function, menstrual cycles can be established, though pregnancy may be difficult to achieve.
Regular School Health Talks at Jamnagar Gujarat Report by Dr. kalpana khandheria, Executive Committee member Adolescent Health Committee FOGSI
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