Congenital Anomalies: A Colour Atlas of Ileal Neovagina (Volume 33) Narendra Malhotra, Arun Nagrath, Manju Nagrath
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1Single Surgical Procedures in Obstetrics and Gynaecology–31: CONGENITAL ANOMALIES A Colour Atlas of Ileal Neovagina2
3Single Surgical Procedures in Obstetrics and Gynaecology–31: CONGENITAL ANOMALIES A Colour Atlas of Ileal Neovagina
Series Editors Arun Nagrath MS MAMS FICOG Professor and Head Department of Obstetrics and Gynaecology Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India Erstwhile Professor and Head Department of Obstetrics and Gynaecology SN Medical College, Agra, Uttar Pradesh, India Senior Clinical Training Consultant Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO), Baltimore, USA Narendra Malhotra MD FICOG FICMCH President, FOGSI 2008 Dean, ICMU 2008-2009 Director, Ian Donald School of Ultrasound Consultant and Director Malhotra Nursing and Maternity Home (P) Ltd., Agra, Uttar Pradesh, India Apollo Pankaj Hospital (P) Ltd., Agra, Uttar Pradesh, India Associate Editor Manju Nagrath MS Senior MO Department of Radiodiagnosis Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India
4
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Single Surgical Procedures in Obstetrics and Gynaecology–33: A Colour Atlas of Ileal Neovagina
First Edition: 2013
9789350902912
Printed at
5Dedication
One of the legendry artists' surgeons of India who excelled and afforded respect to a newly formed specialisation Gynaecological and Obstetrical Surgeries.
Famous in the 50s, 60s and 70s fondly called Teacher of Teachers.
Through this great master I see a glimpse of his surgical mannerisms in my work trying to achieve surgical perfection which came so naturally to him.
Lest he be forgotten in the footprints of time a humble effort to propagate his excellence through this organisation for posterity.
….lest the coming generations be starved of the magical art of gynaecological and obstetrical surgery.
Arun Nagrath
6
7Preface
Anything that simplified our medical education has always been welcomed. This book is organised into multiple volumes on all gynaecological and obstetrical surgical procedures related to the female genital organs. Special sections are dedicated to patient positioning, type of incision, their closures along with proper use of drains, suture choices, etc. This volume deals with the creation of an ileal neovagina.
We have followed the advice given to Alice when about to testify at the trial of the Knave of Hearts in Wonderland, “Begin at the beginning, keep on until you come to the end and then stop”.
In crafting the book we have attempted to follow a logical sequence by dividing it into the introduction, preoperative, intraoperative and postoperative care.
Also included in this section are chapters describing in detail both the more traditional and newer surgical procedures and discuss their place and outcomes. Where feasible, we have substantiated the choice of surgical manoeuvres with good science.
Vaginal agenesis is an uncommon condition, with an incidence ranging from 1 in 4,000 to 1 in 10,000. Congenital absence of uterus and vagina, also called müllerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome, is the most common factor requiring creation of neovagina. Müllerian development is distinct from ovarian development and thus müllerian agenesis generally occurs without affecting the ovaries and normal external genitalia.
However, creation of neovagina may also be considered after vaginectomy, as from carcinoma, after extensive scarring from trauma or infection or in the case of male to female trans-sexual surgery. Using the ileum to form a vaginal conduit is an operation not performed by many gynaecologists. The success of this surgery and the postoperative satisfaction of both the patient and surgeon prompted us to include this case in the Series of Single Surgical Procedures.
The book is enhanced by full colour illustrations and photographic reproductions. Special attention has been paid to the illustrations and photographs to make them more accessible and informative. The technical description is superb and to the point.
We as editors of this Colour Atlas of Gynecologic Single Surgical Procedures in Obstetrics and Gynaecology have set out to simplify surgery by creating a step-by-step procedural process, illustrated to emphasise those surgical steps, which are critical to the individual procedure under consideration.
We have also provided important notes in an effort to aid the surgeon in reducing blood loss, minimising complication rates and improving their surgical skills.
We hope that our efforts will provide a coherent, integrated account of the field we have attempted to cover, which will be to the satisfaction of our readers.
There is no doubt that readers will thoroughly enjoy this work as we have.
Series Editor, Dr Arun Nagrath is one of the accomplished and renowned Obstetrics and gynaecology surgeon. He has gained excellence especially in non-descent vaginal hysterectomy. Based on his merits and rich expertise, John Hopkins University inducted him as a consultant.8
In case, you want to give any suggestion or feedback you may contact him on the following address:
Permanent Address
4/16, Lala Lajpat Rai Road, Civil Lines
Agra – 282002 (UP), India
Present Address:
103 A, Varishtha Chikitsa Adhikari Awas
UPRIMS & R, Saifai, Etawah 206301 (UP), India
Contact Numbers: 09319112861, 09410666674
Arun Nagrath
Narendra Malhotra
Manju Nagrath
9Acknowledgements
I am grateful to Director, Brig T Prabhakar, who has a fixation for quality and continued progress, dedicated to his institution. He has always cajoled his staff to move forwards and do something that “makes a difference”. Though he is not heading the institution today, his infectious zeal of toil and excellence continues to inspire us.
My better half, Dr (Mrs) Manju Nagrath, Department of Radiodiagnosis, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India, who has stood by me, tolerating my hours of frustration and its manifestations and constantly encouraging me to “keep up” my endeavours and see this work through completion. A gynaecologist herself, she has always been by my side helping me at every step through the completion of this volume. Involved more in radiodiagnosis at present some of my works so impressed her that she joined hands with me in the preparation of the manuscripts and seeing the document through its completion.
The preparation of the book of this magnitude involves many individuals who play an important role in its creation. I am especially proud of the quality of the photographs and it would be in place to put on record the contribution of Mrs Geeta Jha, nursing sister in charge, who has shouldered the additional responsibility of helping me in the photography apart from providing facilities in the “State of Art” operation theatre in the Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
I would also thank you, the readers for your constant quest for knowledge to enhance the goal of improved surgical care.
It is my fervent hope that this work will benefit all the post graduates. I hope that these individual Single Surgical Procedures volumes will stimulate the reader to a greater understanding and thereafter a healthy appetite for more surgical knowledge.
Arun Nagrath10
11All Volumes in the Series “Single Surgical Procedures in Obstetrics and Gynaecology”
This book is one of the titles in the series of Single Surgical Procedures in Obstetrics and Gynaecology, a series which will eventually have 36 volumes.
If you wish to be kept informed of new additions to the series and receive details of our other titles, please write to Jaypee Brothers Medical Publishers (P) Ltd at sujatha.jp@gmail.com.
We list below a few of the other titles in print and in preparation in the Single Surgical Procedures series. Titles already published are marked (*); those titles to be published during the coming months are marked (#).
VULVA. - A
*VOL-1
Bartholin's gland excision
Marsupilisation of Bartholin cyst
Release of labial fusion
VOL-2
Hymenectomy (Imperforate hymen)
Simple vulvectomy
VAGINA - B
VOL-3
Anterior colporrhaphy and Kelly's plication
Posterior colpoperineorrhaphy
Vaginal repair of enterocoel
Abdominal repair of enterocoel
*VOL-4
Complete perineal tear repair
VOL-5
Fenton's operation
Episiotomy
Schuchardt's operation
CERVIX - C
VOL-6
Biopsy of cervix
Cervical conisation
Endocervical curettage at colposcopy
Conisation of cervix by LEEP
Electrocauterisation of cervix
Cervical cryocauterisation
VOL-7
Trachelorrhaphy
Abdominal excision of cervical stump
VOL-8
Correction of incompetent cervix by Shirodkar's technique
Correction of incompetent cervix by McDonald's operation
Correction of incompetent cervix by Lash operation
UTERUS: ABDOMINAL HYSTERECTOMY-D1
VOL-9
Total abdominal hysterectomy
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
Nagrath's minilap hysterectomy
VOL-10
Abdominal subtotal hysterectomy
Obstetrical hysterectomy
UTERUS: VAGINAL HYSTERECTOMY-D2
VOL-11
NDVH - Conventional approach
NDVH - With salpingo-oophorectomy
NDVH - Debulking by uterine bisection
NDVH - Debulking by wedge excision
NDVH - Debulking by myomectomy
NDVH - Debulking by morcellation
NDVH - Debulking by Coring
NDVH - Debulking by spiral incision
NDVH - Debulking by cervical amputation
NDVH - Debulking by cervical wedge
*VOL-12
Ward Mayo's hysterectomy
Modified Ward Mayo's hysterectomy– Dr Nagrath's modification
Clampless vaginal hysterectomy
UTERUS-D3
VOL-13
Dilatation and curettage
Suction curettage for abortion
Dilatation and endometrial biopsy
Fractional curettage
*VOL-14
Upper segment caesarean section
Lower segment caesarean section
UTERUS: DISPLACEMENTS-D4
*VOL-15
Cervicopexy (Purandare's)
*VOL-16
Supravaginal cervical amputation (Nadkarni's)
VOL-17
Manchester's operation
Fothergill's repair
VOL-18
Shirodkar's anterior sling
Shirodkar's posterior sling
VOL-19
LeFort's operation
Gilliam's operation
Modified Gilliam's operation
William Richardson's operation
*VOL-20
Ventral suspension of vaginal vault
Abdominal sacro-colpopexy
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UTERUS: MYOMECTOMY-D5
VOL- 21
Myomectomy for Fundal fibroid, Hood's operation
Myomectomy for anterior wall fibroid
Myomectomy for isthmic fibroid
Myomectomy for anterior cervical fibroid
Myomectomy for posterior wall fibroid
Myomectomy for intracavitary fibroid
Myomectomy for fibroid polyp
Myomectomy for broad ligament fibroid
Myomectomy for round ligament fibroid
Myomectomy for multiple fibroids
FALLOPIAN TUBES AND OVARIES-E1
VOL-22
Salpingo-oophorectomy
Wedge resection of ovary
Ovarian cystectomy
Ovariotomy
VOL-23
Enucleation of broad ligament cyst
Ectopic pregnancy
FALLOPIAN TUBE RECONSTRUCTION-E2
VOL-24
Salpingolysis
Fimbriolysis
Salpingo-ovariolysis
Salpingostomy
Salpingectomy
VOL-25
Cornual reimplantation
Fimbrioplasty
Tuboplasty–Microresection and anastomosis
FEMALE STERILISATION-E3
VOL-26
Laparoscopic sterilisation by silastic bands Sterilisation by minilaparotomy technique
Sterilisation by Pomeroy's operation
Sterilisation by modified Pomeroy's operation
Sterilisation by Irving's method
Sterilisation by Uchida's method
Sterilisation by Madlener's method
Sterilisation by Parkland's method
Sterilisation by Aldridge method
Sterilisation by Kroener's method
Sterilisation by Oxford's method
Sterilisation by Shirodkar's method
Fimbriectomy
ABDOMINAL WALL-F
*VOL-27
Infra-umbilical midline laparotomy
Paramedian abdominal incision
Pfannenstiel's incision
Kustner's incision
Maylard's incision
Cherney's incision
VOL-28
Abdominal closure
Single layer abdominal closure
Skin closure methods
Use of drains
Incisional hernia repair
URINARY STRESS INCONTINENCE-G
VOL-29
Retropubic urethropexy
Kelly's operation
Marshall Marchetti Krantz operation
Burch suspension operation
CONGENITAL ANOMALIES-HI
VOL-30
Strassmenn's utriculoplasty
Jone's utriculoplasty
Tompkin's utriculoplasty
*VOL-31
Excision of transverse vaginal septum
Excision of longitudinal vaginal septum
VOL-32
Mc Indoe's vaginoplasty
Modified McIndoe's vaginoplasty
William's vulvo-vaginoplasty
*VOL-33
Ileal neovagina
FISTULA OPERATIONS
VOL-34#
Layer method of RVF
Sim's Moir saucerisation
Latzko's operation
VOL-35
Urethral reconstruction
Vesicovaginal fistula
Vesicocervical fistula
Ureterivaginal fistula
MISCELLANEOUS OPERATIONS-J
VOL-36
Intestinal loop urinary diversion
Urinary diversion cutaneous ureterostomy
Urinary diversion uretero-sigmodostomy
Ureterovesicle anastomosis (psoas hitch)
Posterior colpotomy
Insertion of suprapubic catheter
Demonstration of tubal patency via laparoscopy
Demonstration of tubal patency by HSG