In April 2000 (IPEG meeting), we presented the first patient who underwent laparoscopic sigmoid vaginal replacement. An update on our experience with this procedure in 14 consecutive patients has been published in Pediatric Endosurgery & Innovative Techniques (Dec 2004, Vol. 8, No. 4:295-301).
Forty four patients had been operated up till now.
Their mean age was 16.3 years. Thirty eight had a Müllerian dysgenesis and 6 a disorder of sexual differentiation (DSD). All patients were previously informed about different techniques and chose this procedure.
We used 4 ports: a 10mm one (umbilical), a 12mm (right lower quadrant) and two 5mm (left lower quadrant and hypogastric) ones. The lens was initially introduced through the umbilical port and afterwards inserted through the right lower quadrant one in order to achieve a better visualization of the vascularization of the sigmoid. After isolating a segment of the sigmoid using bipolar or a bipolar sealer device and 2 endostaplers, we undertook a perineal dissection creating a space between the urethra and the rectum under laparoscopic vision. Colo-colonic anastomosis was achieved using a circular mechanical suture through the rectum and taking outwards the proximal end of the colon through the umbilicus or the right lower quadrant port site. Both the ensemble and shooting were done under laparoscopic control. The peritoneum near the Douglas's space was incised in order to allow the passage of a forceps from the perineum, which enabled the descent of the isolated bowel.
Mean operative time was 2.5 hours (1.5-6hs). There were no intraoperative or postoperative complications except for an accidental opening of the bladder that was sutured laparoscopically. All patients were able to tolerate food after 24 hours and 42 were discharged during the third postoperative day. Viability and patency of neovagina are excellent after a mean follow-up of 42 months (4- 84 m) and 22 patients are sexually active.
We conclude that laparoscopy makes the Pratt procedure more attractive while waiting for culture of vaginal epithelium to be available.

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