Innovative abdominoperineal surgery for fertility-preserving cervicovaginal reconstruction in five patients with the rare condition of congenital cervical malformation coexisting with vaginal atresia

Abstract

Congenital cervical malformation coexisting with vaginal atresia is a rare but challenging anomaly that obstructs menstrual outflow and threatens future fertility. This study aimed to describe a fertility-preserving laparoscopic abdominoperineal cervicovaginal reconstruction technique and present preliminary clinical outcomes from a small case series. In this retrospective case series, between September 2019 and June 2024, five patients diagnosed with congenital cervical malformation coexisting with vaginal atresia through clinical evaluation and imaging were treated at Renmin Hospital of Wuhan University. All patients subsequently underwent fertility-preserving laparoscopic abdominoperineal cervicovaginal reconstruction. Key surgical steps included anatomical preservation of the ascending branches of the uterine artery to help preserve uterine blood supply, resection of the atretic cervical segment with conservation of viable cervical tissue containing mucosa whenever feasible, mobilization of pelvic peritoneum to cover the lower uterine segment and neocervix, and placement of a self-assembled modified T-shaped utero-vaginal device to sustain neocervical canal patency. Postoperative and functional outcomes were assessed by clinical follow-up, ultrasonography, and hysteroscopic evaluation. All five patients successfully underwent laparoscopic-vaginal reconstruction without intraoperative complications or conversion to laparotomy. The mean patient age was 14.2 ± 1.72 years (range, 12–17). No intraoperative complications occurred. Normal menstrual flow resumed in all cases within one month after surgery. During a mean follow-up of 23.6 ± 9.0 months, no restenosis, hematometra, infection, or recurrent obstruction occurred. Ultrasonography consistently demonstrated stable uterovaginal continuity, normal uterine morphology, and adequate neovaginal length throughout the follow-up period. This small case series suggests that laparoscopic abdominoperineal cervicovaginal reconstruction may be a feasible fertility-preserving option for selected patients with congenital cervical malformation coexisting with vaginal atresia. The procedure restored menstrual outflow and achieved stable early uterovaginal patency, but further studies with larger cohorts and longer follow-up are required to validate its safety, reproducibility, and fertility-related value.