LAPAROSCOPIC PERITONEAL PULL-THROUGH VAGINOPLASTY FOR VAGINAL AGENESIS IN MRKH SYNDROME: A CASE REPORT

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is defined by the congenital absence of the vagina and uterus in 46, XX females with normal secondary sexual characteristics, affecting approximately 1 in every 4,500–5,000 live female births [1]. Several surgical techniques have been described for neovaginal creation, including the Davydov peritoneal vaginoplasty and its variations [2]. Case Presentation: A 17-year-old female from Sindh, Pakistan, presented with primary amenorrhea and an inability to consummate marriage. Clinical, hormonal, and imaging tests revealed a blind vaginal pouch (2–3 cm) with rudimentary uterine horns and normal ovaries, consistent with MRKH syndrome. Intervention: We performed a single-stage laparoscopic peritoneal pull-through vaginoplasty with posterior peritoneal flaps from the pouch of Douglas and mobilized rudimentary uterine horns for anterior wall formation. To maintain patency, the anteroposterior peritoneal flaps were sutured at the introitus using tailored soft and hard vaginal molds. Results: The procedure was completed without any intraoperative complications. The neovagina was 9 cm deep at discharge and had adequate diameter and epithelialization at the 6-month follow-up. Sexual activity was successfully resumed at 8 weeks postoperatively, with satisfactory functional results. This case demonstrates the feasibility of combining the Davydov technique with peritoneal pull-through and uterine-horn support—similar to the Kisu modification [3]—to achieve a long-lasting, self-epithelializing neovagina. Conclusion: Laparoscopic peritoneal pull-through vaginoplasty with uterine-horn incorporation is a viable, minimally invasive option for vaginal reconstruction in MRKH syndrome, yielding good anatomical and functional outcomes.