Surgery for Congenital Absence of the Vagina: Results and Complications of 108 Consecutive Patients

This study includes 108 patients with vaginal agenesis subjected to surgical vaginoplasty. The indication for vaginoplasty was Mayer-Rokitansky-Kuster-Hauser syndrome in 94 (87.0%), testicular feminization in 12 (11.1%), and hermaphroditism in 2 (1.9%) patients. The surgical procedures employed were Wharton in 53 patients (49.0%), McLndoe in 47 (43.5%), gracilis myocutaneous flap in 3 (2.8%), sigmoid loop vaginoplasty in 2 (1.9%), and vaginoplasty using amnion in 3 (2.8%) patients. The overall anatomic success rate after vaginoplasty was 75.0% (81/108). This figure varies from 78.7% for patients subjected to the McLndoe procedure to 71.6% for patients having Wharton vaginoplasty. Rectovaginal fistula was observed in only 3 patients (2.7%). The other leading complications were febrile morbidity in 13 (12.0%), infected hematoma in the neovagina in 2 (1.8%), and localized infection in 8 (7.4%) patients. Granulation tissue was observed in the neovagina in 12 patients. Wharton and McLndoe operations represent the procedures of choice in patients with congenital absence of the vagina. However, serious complications, such as fistula, may occur following surgery.