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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

Correction of Double-Barreled Vagina

The Mullerian ducts are said to account for the upper one-third of the vagina. Their failure to fuse can leave the vaginal canal with a longitudinal horizontal septum that may extend from the upper vagina as far as the vaginal outlet. This condition, known as a "double-barreled vagina," is frequently unnoticed by the patient until an initial gynecologic examination or delivery of the first baby. It requires the surgeon to perform an appropriate workup for failure of the other structures derived from the Mullerian ducts, such as the cervix and the uterus. In addition, some patients with Mullerian duct abnormalities have concomitant urinary tract abnormalities and, therefore, an intravenous pyelogram (IVP) may be indicated. The best procedure for correcting the longitudinal septum is excision.

The purpose of the operation is to create a single-barreled vagina and, at the same time, avoid dyspareunia.

Physiological Changes. A normal vagina is created.

Points of Caution. In creating a single-barreled vagina, the surgeon must be careful not to remove excessive vaginal mucosa.


The longitudinal septum is demonstrated in this cutaway section.

With the patient in the dorsal lithotomy position, the vulva and vagina are prepped, the patient is draped, and the bladder is emptied by catheterization. Adequate exposure to each vaginal canal is made by lateral retractors. The longitudinal septum is grasped with a clamp or tissue forceps and slight traction is applied. Extreme traction should be avoided in order not to tent the underlying urethra and bladder tissue into the area to be excised. The junction of the longitudinal septum and vaginal mucosa should be excised with scissors. The same procedure is carried out at the junction of the longitudinal septum on the posterior vaginal wall. A defect is made in the anterior and posterior vaginal walls that should extend no deeper than the pubovesical cervical fascia anteriorly and the perirectal fascia posteriorly.

Primary repair can be carried out by closing the defect with interrupted 2-0 synthetic absorbable suture.

The same technique is used to repair the
posterior vaginal wall.

The repair is completed. No vaginal pack is left in the vagina, and no catheter is needed for drainage of the bladder. The patient can usually be discharged within 1-2 days after the operation and can resume sexual intercourse 1 month after closure of the vaginal incision.

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