Transverse Retubularized lleal Vaginoplasty: A NewApplication of the Monti Principle-Preliminary Report

Obiective: The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. Herein we present our successful experience with va-einal reconstruction by the use of a modified ileal segment according to the Monti principle. Methods: Six patients aged fiom 23 to 4l years (mean 33 years) were referred to our institr"rtion for vaginal stenosis. In our series, ileum has been used to create the neovagina: the isolated sesment has been longitudinally detubularized and transversally retubularized in order to conlìgure the roof of the neovasina. Results: The mean operating time was 220 min. No intra-operative complication occurred. The mean follow-up of this series was l6 months. At the latest follow-up, all patients had patent moisr neova_sinas. but excessive vaginal m,.rcous was not a problem in any patient in our series. Crtnc{usions.' Neovaginal creation using isolated ileal segments accordin-e to the Monti channel principle provide excellent tissue for vaginal replacement, providing excellent patient satisfaction and relatively low morbidity. Cosmetic, functional and anatomical results were encouraging. In our opinion our technique may be indicated for all cases of vaginal absence: congenital abnormalities in the pediatric popr,rlation. va-uinal stenosis after treatment of pelvic tumors, severe vaginal scarrin-e secondary to chronic inflammatory disease or in case of secondary correction after failure gender surgery.

Objective: The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. Herein we present our successful experience with vaginal reconstruction by the use of a modified ileal segment according to the Monti principle. Methods: Six patients aged from 23 to 41 years (mean 33 years) were referred to our institution for vaginal stenosis. In our series, ileum has been used to create the neovagina: the isolated segment has been longitudinally detubularized and transversally retubularized in order to configure the roof of the neovagina. Results: The mean operating time was 220 min. No intra-operative complication occurred. The mean follow-up of this series was 16 months. At the latest follow-up, all patients had patent moist neovaginas, but excessive vaginal mucous was not a problem in any patient in our series. Conclusions: Neovaginal creation using isolated ileal segments according to the Monti channel principle provide excellent tissue for vaginal replacement, providing excellent patient satisfaction and relatively low morbidity. Cosmetic, functional and anatomical results were encouraging. In our opinion our technique may be indicated for all cases of vaginal absence: congenital abnormalities in the pediatric population, vaginal stenosis after treatment of pelvic tumors, severe vaginal scarring secondary to chronic inflammatory disease or in case of secondary correction after failure gender surgery. © 2005 Elsevier B.V. All rights reserved.