1. The use of acellular porcine small intestinal submucosal grafts allowed for successful surgical reconstruction of a neovagina.
2. No incidences of cervical or vaginal stenosis were observed over an 8 month mean follow-up period.
Evidence Rating Level: 2 (Good)
Study Rundown: This observational study used acellular porcine small intestinal submucosal (SIS) grafts to perform cervicovaginal reconstruction and found the technique was associated with favorable outcomes. Existing treatment modalities for dysgenesis of the cervix and vagina include canalization techniques (e.g. use of sequential dilators), uterovaginal anastomosis and reconstruction with autologous tissues. The present work introduces a new technique that may be a suitable treatment option.
Limitations include small sample size and lack of a control arm. Future studies might employ an RCT design, comparing porcine grafts with one of the other current standards of care, with longer-term follow-up to compare cosmesis, rates of stenosis and need for reoperation, among other outcomes. Further, investigation into the use of porcine small intestine for creation of neovaginas in patients undergoing gender reassignment surgery is merited.
In-Depth [prospective observational study]: This study evaluated the efficacy of combined laparascopic and vaginal cervicovaginal reconstruction using porcine small intestinal submucosal grafts in women with cervical and vaginal agenesis or dysgenesis (n=8). Primary outcomes evaluated include intra- and post- operative complications, cervical or vaginal stenosis, vaginal length and achievement of menstruation.
No intra- or post-op complications were noted and no cases of cervical or vaginal stenosis occurred during the follow-up period (8 ± 4 months). Median vaginal length at 1 month was 7.8 ± 1 cm. All patients achieved menstruation.
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