Surgical Management
Examination under general anaesthesia was performed in a lithotomy
position. Thick labial adhesions made identification of dissection
planes challenging. A finger was placed in the rectum to delineate its
relative position and avoid inadvertent injury. A mixture of blunt and
sharp dissection with gentle probing using a Size 3 Hegar dilator was
utilised to first open the vestibule [Figure 2]. Once the urethra
was revealed, it was cannulated with a two-way 16 french Foley catheter
[Figure 3]. The vaginal orifice was then opened and stretched with
two parallel Sims speculums to a width of 4cm, releasing accumulated
cervico-vaginal secretions. The cervix was visualised and cannulated
with Hegar dilators to demonstrate uterovaginal continuity and
endometrial curettage was performed to exclude intrauterine pathology.
An anti-adhesion gel consisting of sodium hyaluronate and sodium
carboxymethylcellulose [Guardix SolĀ®, Genewal Co, South Korea] was
applied to the raw surfaces of the introitus. A vaginal mould was
fashioned using sterile foam obtained from a negative pressure wound
therapy set. This was sheathed by 2 condoms to give it shape [Figure
4]. This was also covered in the same antiadhesion gel and secured
with a gamgee tissue for three days before being removed prior to
inpatient discharge.