Excision of Transverse Vaginal Septum Transverse vaginal septum generally occurs between the upper one-third and lower two-thirds of the vaginal canal. This is additional evidence that the upper one-third of the vagina is of Mllerian origin and that the lower two-thirds of the vagina is embryologically developed via the urogenital sinus. The septum can be either complete or partial. If it is complete, the symptoms of vaginal obstruction occur at the time of menarche, since menstrual blood is entrapped above the septum and has no egress from the vagina. If the septum is partial, it may be discovered on a routine gynecologic examination, or the patient may present with dyspareunia. The operation is performed to remove the transverse vaginal septum without significantly shortening the vaginal canal. Physiologic Changes. The physiologic changes desired are (1) the egress of menstrual blood from the vaginal canal without obstruction and (2) the normal functioning of the vagina. Points of Caution. If the septum is complete and hematometra or hematocolpos is present, it is unwise to attempt surgical correction of the septum at the time the obstruction is relieved. The procedure of choice is incision and drainage of the hematometra or hematocolpos, with reconstruction delayed 6-8 weeks until the tissues have completely healed. To avoid unduly shortening the vagina, excessive vaginal mucosa should not be removed. Technique The typical position of most transverse vaginal septa at the junction of the upper one-third and the lower two-thirds of the vagina is shown. B, bladder. With the patient in the dorsal lithotomy position, the perineum is prepped and draped, and adequate vaginal retraction is applied to allow exposure of the septum, which is incomplete here. Initially, the septum is grasped with Allis clamps, and a vertical incision is made through the septum to divide it in half. The septum is picked up with tissue forceps, traction is applied, and with a scalpel the septum is separated from the vaginal mucosa. The vaginal mucosa is then approximated with interrupted 3-0 synthetic absorbable suture throughout its circumference. A sagittal view illustrates closure of the defect in the vaginal mucosa.

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Vagina and Urethra

Anterior Repair and Kelly Plication

Site Specific Posterior Repair

Sacrospinous Ligament Suspension of the Vagina

Vaginal Repair of Enterocele

Vaginal Evisceration

Excision of Transverse Vaginal Septum

Correction of Double-Barreled Vagina

Incision and Drainage of Pelvic Abscess via the Vaginal Route

Sacral Colpoplexy

Le Fort Operation

Vesicovaginal Fistula Repair

Transposition of Island Skin Flap for Repair of Vesicovaginal Fistula

McIndoe Vaginoplasty for Neovagina

Rectovaginal Fistula Repair

Reconstruction of the Urethra

Marsupialization of a Suburethral Diverticulum by the Spence Operation

Suburethral Diverticulum via the Double-Breasted Closure Technique

Urethrovaginal Fistula Repair via the Double-Breasted Closure Technique

Goebell-Stoeckel Fascia Lata Sling Operation for Urinary Incontinence

Transection of Goebell-Stoeckel Fascia Strap

Rectovaginal Fistula Repair via Musset-Poitout-Noble Perineotomy

Sigmoid Neovagina

Watkins Interposition Operation

Excision of Transverse Vaginal Septum

Transverse vaginal septum generally occurs between the upper one-third and lower two-thirds of the vaginal canal. This is additional evidence that the upper one-third of the vagina is of Mullerian origin and that the lower two-thirds of the vagina is embryologically developed via the urogenital sinus.

The septum can be either complete or partial. If it is complete, the symptoms of vaginal obstruction occur at the time of menarche, since menstrual blood is entrapped above the septum and has no egress from the vagina. If the septum is partial, it may be discovered on a routine gynecologic examination, or the patient may present with dyspareunia.

The operation is performed to remove the transverse vaginal septum without significantly shortening the vaginal canal.

Physiologic Changes. The physiologic changes desired are (1) the egress of menstrual blood from the vaginal canal without obstruction and (2) the normal functioning of the vagina.

Points of Caution. If the septum is complete and hematometra or hematocolpos is present, it is unwise to attempt surgical correction of the septum at the time the obstruction is relieved. The procedure of choice is incision and drainage of the hematometra or hematocolpos, with reconstruction delayed 6-8 weeks until the tissues have completely healed.

To avoid unduly shortening the vagina, excessive vaginal mucosa should not be removed.

Technique

The typical position of most transverse vaginal septa at the junction of the upper one-third and the lower two-thirds of the vagina is shown. B, bladder.

With the patient in the dorsal lithotomy position, the perineum is prepped and draped, and adequate vaginal retraction is applied to allow exposure of the septum, which is incomplete here. Initially, the septum is grasped with Allis clamps, and a vertical incision is made through the septum to divide it in half.

The septum is picked up with tissue forceps, traction is applied, and with a scalpel the septum is separated from the vaginal mucosa.

The vaginal mucosa is then approximated with interrupted 3-0 synthetic absorbable suture throughout its circumference.

A sagittal view illustrates closure of the defect in the vaginal mucosa.