Sexual and functional outcomes of vaginoplasty using acellular porcine small intestinal submucosa graft or laparoscopic peritoneal vaginoplasty: a comparative study

STUDY QUESTION Can vaginoplasty in patients with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS) be achieved using an acellular porcine small intestinal submucosa (SIS) graft? SUMMARY ANSWER Vaginoplasty using SIS graft was successfully achieved in women with MRKHS, and the anatomical and functional outcomes of this procedure were comparable to those of laparoscopic peritoneal vaginoplasty. WHAT IS KNOWN ALREADY There is a great variety of vaginal reconstruction techniques, which suggests there is no single superior surgical technique. STUDY DESIGN, SIZE, DURATION This prospective observational study included 34 patients with congenital vaginal agenesis who underwent vaginoplasty using SIS graft (the SIS group) between December 2011 and July 2013, and 41 patients with the same disease who underwent laparoscopic peritoneal vaginoplasty (the Davydov group) between January 2008 and July 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS Patient and surgical data, follow-up information, and the female sexual function index (FSFI) scores in the two groups were analysed and compared. MAIN RESULTS AND THE ROLE OF CHANCE Compared with the laparoscopic Davydov procedure, the operating time of vaginoplasty using SIS graft was significantly shorter, and the estimated blood loss was significantly less. Patients in the SIS group had an earlier return of bowel activity, and an earlier return to work. However, the total cost in the SIS group was significantly higher than that in the Davydov group due to the cost of the SIS graft ($3525 per graft). Most patients (28/34 in the SIS group and 37/41 in the laparoscopic Davydov group) returned for their follow-up 9 months post-surgery. The mean length of the neovagina in the SIS group seemed slightly shorter than that in the Davydov group (6.8 ± 0.9 cm versus 7.3 ± 1.3 cm, P = 0.081). Thirteen patients (46%) in the SIS group and 11 (29%) in the Davydov group had a neovagina