Comparison of improved laparoscopic peritoneal vaginoplasty and gasless laparoscopic ileal vaginoplasty in treatment of androgen insensitivity syndrome.

Purpose: To investigate a better approach for androgen insensitivity syndrome (AIS) treatment using laparoscopic peritoneal or ileal vaginoplasty.

Method: Improved laparoscopic peritoneal vaginoplasty and gasless laparoscopic ileal vaginoplasty were, respectively, applied to AIS patients in vaginal reconstruction. The operation condition and surgical results were summarized and follow-up was performed from the 5th week after operation, then once a month. The sexual function was scored by Female Sexual Function Index (FSFI), and FSFI score >30 represented a very good sexual function, 25-30 as good, and <25 as bad.

Result: The operation time (including gonadal resection and genital plastic surgery) of improved laparoscopic peritoneal vaginoplasty was 77.2 ± 18.9 (55-105) min, while of ileal vaginoplasty was 183.3 ± 30.1 (155-215) min, longer than peritoneal vaginoplasty, and the bleeding amount was 7.2 ± 13.0 (5-30) versus 50.0 ± 30.0 (20-80) mL, respectively. The surgery was successful in all 12 cases without complications. During 1 month to 7 years follow-up, the depth of artificial vagina was approximately 8-12 cm after peritoneal vaginoplasty, while 6-11 cm after ileal vaginoplasty. The vaginal mucosa appeared as normal in all cases. Besides, 4/9 cases had normal FSFI score after peritoneal vaginoplasty while only 1/3 case after ileal vaginoplasty.

Conclusion: The peritoneal vaginoplasty seems better than the ileal vaginoplasty because of the shorter operation time, less bleeding, rapid recovery, less trauma and scar, easy operating and early sexual life without mold. But the treatment should be individualized and comprehensive considering the patient anatomical characteristics and other factors.