Surgical Techniques for the Prolapse of Neovagina in Women: Case Report and Review of Literature

INTRODUCTION: A neovaginal prolapse is a rare condition. Only a few cases have been reported and described in literature. The surgical management is complex and depends on the initial surgical techniques for the reconstruction of a neovagina applied. We present a case of a stage IV prolapse of a sigmoid vaginal prolapse and a review of surgical procedures in literature. METHODS: We describe the case of a 41-year-old woman with a stage IV prolapse of a sigmoid neovagina who presented 20 years after the initial reconstruction due to a botryoid sarcoma of the pelvis in the childhood. The initial surgical repairs with a fixation of the apex of the sigmoid vagina to the sacral promontory with resorbable suture and consecutively in a second procedure with a polypropylene mesh failed. The interdisciplinary approach with the colorectal team which included a significant shortening of the neovagina prior to the mesh fixation led to a stable repair of the prolapse. CONCLUSION: Only a few cases of women with a prolapse of a sigmoid neovagina are published. An interdisciplinary approach including a significant shortening of the neovagina and the fixation with a non-absorbable mesh was necessary to achieve a successful repair. The surgical techniques to create a sigmoid neovagina are crucial in order to perform successful later reconstructive surgery if indicated. Our experience in this case is consistent with the findings from our literature review.