Creatsas modification of Williams vaginoplasty: More than 20 years of experience

LETTER TO THE EDITOR Creatsas modification of Williams vaginoplasty: More than 20 years of experience To the Editor: In the Fertility and Sterility article entitled ‘‘Creation of a neovagina in Rokitansky patients with a pelvic kidney: comparison of long-term results of the modified Vecchietti and McIndoe techniques,’’ published on January 24, 2009, Fedele et al. (1) discuss the efficacy of the Williams vaginoplasty as a method of treatment for colpopoiesis in patients with Mayer-Rokitansky-K€ uster-Hauser (MRKH) syndrome with a pelvic kidney and compare the safety and efficacy of this method with those of Vecchietti’s laparoscopic modification. According to authors, as expressed in the Discussion section,: ‘‘The extraperitoneal approach implied in the Williams techniques certainly minimizes the risks associated with the presence of a pelvic kidney. This vaginoplasty technique also has the advantage of having an extraperitoneal approach and being a relatively simple procedure.’’ It is true that, due to the nature of the procedure, Williams vaginoplasty is indeed the safest method to perform for the creation of a neovagina, especially in this subgroup of patients with MRKH syndrome, as no dissection of the vesicorectal space is required. Unfortunately, we are not in position to agree with authors’ further statement that ‘‘the presence of perineal hair and the nonphysiologic external angle of the neovagina that results from this technique do not allow optimal anatomical results.’’ According to our experience, published several times in the past (2–4), after the performance of the Williams vaginoplasty, the functional axis of the neovagina tends to be very similar to the anatomical deviation of a normal vagina. Furthermore, we would like to assure you that, despite the fact that initially we were also surprised, during the long-term follow-up of 200 cases treated by the Creatsas modification

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of the Williams vaginoplasty, over a course of more than 20 years, we have found no perineal hair present at the inner segment of the neovagina. In conclusion, we strongly believe that for the creation of a neovagina, especially in case of contemporaneous existence of a pelvic kidney, the simplest, quickest, most effective, and, beyond all, safest method, is the Creatsas modification of the Williams vaginoplasty. George Creatsas, M.D., Ph.D., F.A.C.S., F.R.C.O.G., F.A.C.O.G. Panagiotis Christopoulos, M.D., M.Sc., Ph.D. Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery Second Department of Obstetrics and Gynecology University of Athens Medical School Aretaieio Hospital Athens, Greece July 28, 2009 G.C. has nothing to disclose. P.C. has nothing to disclose. REFERENCES 1. Fedele L, Frontino G, Motta F, Restelli E, Candiani M. Creation of a neovagina in Rokitansky patients with a pelvic kidney: comparison of longterm results of the modified Vecchietti and McIndoe techniques. Fertil Steril. Published online January 24, 2009 [Epub ahead of print]. 2. Creatsas G, Deligeoroglou E. Expert opinion: vaginal aplasia: creation of a neovagina following the Creatsas vaginoplasty. Eur J Obstet Gynecol Reprod Biol 2007;131:248–52. 3. Botsis D, Deligeoroglou E, Christopoulos P, Aravantinos L, Papagianni V, Creatsas G. Ultrasound imaging to evaluate Creatsas vaginoplasty. Int J Gynaecol Obstet 2005;89:31–4. 4. Creatsas G, Deligeoroglou E, Makrakis E, Kontoravdis A, Papadimitriou L. Creation of a neovagina following Williams vaginoplasty and the Creatsas modification in 111 patients with Mayer-Rokitansky-K€uster-Hauser syndrome. Fertil Steril 2001;76:1036–40.

doi:10.1016/j.fertnstert.2009.08.047

Fertility and Sterility Vol. 92, No. 6, December 2009 Copyright ª2009 American Society for Reproductive Medicine, Published by Elsevier Inc.

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