Laparoscopic Technique Restores Menstrual Drainage

Seven patients with cervicovaginal agenesis and functional uterine remnants underwent laparoscopic reconstruction between 2019 and 2024 at a tertiary referral centre. The procedure aimed to restore menstrual drainage by creating a neovagina and establishing drainage from obstructed uterine remnants. All patients had primary amenorrhea and cyclic or chronic pelvic pain prior to surgery. Preoperative assessment confirmed vaginal agenesis and obstructed uterine remnants with functional endometrium using pelvic ultrasonography and magnetic resonance imaging. The surgical approach combined peritoneal pull-down neovaginoplasty with catheter-guided uterovaginal anastomosis. Laparoscopic-guided vesicorectal dissection was performed first. A peritoneal flap was developed and pulled down to form the neovaginal canal. The obstructed uterine remnant was opened at the site of haematometra and drained. A silicone Foley catheter was placed into the endometrial cavity to maintain patency. In cases with bilateral remnants, both cavities were unified before anastomosis. The uterovaginal anastomosis was completed by suturing the uterine opening to the proximal edge of the pulled-down peritoneum. Custom-made acrylic vaginal moulds with gradually increasing diameters were used postoperatively; the largest measured 3.5 cm in width and 12 cm in length. Patients were instructed to keep the mould inserted continuously during the first postoperative period, except during hygiene care. The intrauterine Foley catheter was left in place until the one-month follow-up. Menstrual drainage was restored in all patients following the procedure. Office hysteroscopy confirmed a patent uterovaginal anastomosis and accessible endometrial cavity in every case. No intraoperative bladder, rectal, ureteric, or vascular complications were reported. One patient underwent two unsuccessful frozen embryo transfer attempts. Another patient required hysterectomy for recurrent pelvic inflammatory disease, though the neovagina was preserved. No late stenosis was observed during the available follow-up period. The study authors note that while anatomical patency was achieved, the presence of an accessible cavity does not confirm normal uterine function, implantation potential, or pregnancy safety. They caution that findings should be interpreted carefully due to the small sample size and limited reproductive follow-up data. Further multicentre studies with objective imaging, hysteroscopic follow-up, and reproductive outcome data are needed to assess fertility potential, pregnancy safety, and long-term durability of the technique. The procedure was approved by the local ethics committee, with written informed consent obtained from all adult patients and parents or legal guardians for minors.