Rare surgery done

Reconstructive surgery gives a new lease of life to people with abnormal body structures. This has been proved successfully by the rare and complex surgery performed by a team of paediatric surgeons from Kasturba Hospital, Manipal, Bangalore, on two teenage girls with cervicovaginal agenesis, a malformation where the cervix and vagina are not developed but all other internal organs of a female like uterus and ovaries are normal. In this malformation, there is no outlet for menstrual flow even though the uterus and ovaries would function normally. Those afflicted with this malformation do not attain menarche and cannot have children as the vagina and cervix are key functional parts for pregnancy.
A team of paediatric surgeons from Kasturba Hospital, Manipal, led by Dr. Vijay Kumar, Professor and Head of
Paediatric Surgery, performed this rare and complex
four-hour reconstruction surgery using intestinal segment, which was connected to the functioning uterus of the patients. By this new concept of reconstruction surgery, not only the uterus was saved, the patients can also lead a normal life like any other girls of their age. Both are doing well and menstruating normally since four-five months. With reference to future possibilities of conception, the surgeons say that will have to wait and see. Right now, there is no literature support in this regard. Both patients were referred from the department of OBG, Kasturba Medical College, Manipal. The patients were not related and there was a gap of two
months between both the surgeries.
Experts say, even though there is no report of such cases or any format of publication, there was one done at CMC, Vellore before. Conventional method of treatment for these patients was the removal of the functioning uterus.
The surgery at Manipal was not without complications. The first and foremost complication was making the patients and parents understand the problem and explaining them this new concept, the advantages and disadvantages of this surgery. Other complexities included surgical technical difficulties like isolating a part of infective, remodeling into vagina, anastamosing (joining) into uterus maintaining the cosmetic outcome of surgery. Recurrent pain in the abdomen, delay in attaining puberty, severe pain during early menstruation are the symptoms for this medical problem.
As for why the surgeries were done only when the patients were in their teens, the surgeons say that usually the presentation happens in the teens because parents consult doctors when girls do not attain menarche. Nobody (including parents) notices the absence of vagina before that. In one of these cases, the patient had to undergo two surgeries outside by local doctors for the same problem without proper diagnosis. However,
it is possible to detect this problem when the child is
an infant.