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Abstract
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Background and Aims Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS), a rare congenital condition (1-9/100,000 women), is characterized by uterine and vaginal agenesis with normal female karyotype and intact ovaries. Management through Vecchietti surgery consists of an acrylic ‘olive’ inserted into the vaginal dimple connected to an abdominal traction mechanism for daily vaginal cavity formation (figure 1).
Methods Description of the perioperative management for a modified Vecchietti surgery. Informed consent for case publication was obtained.
Results A 17-year-old female, ASA II underwent laparoscopic modified Vecchietti technique with suprapubic cystotomy for neo-vagina creation. The patient had well-controlled asthma and anxiety. Before induction, an epidural catheter was placed in the L3-L4 space. The procedure occurred under ASA standard monitorization and balanced general anesthesia with orotracheal tube, for 2 hours, without complications. Post-operatively, pain control was managed through a multimodal approach, including acetaminophen, cetorolac, and epidural analgesia with 1.5mg of morphine every 12 hours, supplemented by 8ml of 0.2% ropivacaine every 6 hours as needed. Epidural analgesia bolus was administered before daily traction. After 8 days, the desired vaginal length was achieved, with device removal and vaginal mold insertion. The epidural catheter was also removed maintaining oral analgesia. The pain remained well-controlled and the patient was discharged on postoperative day 13.
Conclusions The literature on the anesthetic approach to neovagina construction surgery is still scarce. Preoperative anesthetic planning and standardization of anesthetic care are crucial for these patients. In this case, epidural anesthesia played an essential role in postoperative pain control, particularly during daily mechanical traction.
Abdominal traction mechanism for daily vaginal cavity formation