Cervical atresia is fortunately a rare congenital Mullerian anomaly with poor results after surgical corrections. Vaginal aplasia is associated in 50% of these cases. Young, adolescent girls with a functional uterus above an atretic or a dystretic cervix underwent repeated unsuccessful attempts at reconstruction of the cervix which eventually led to a hysterectomy. This was the fate of most of these teenagers almost a decade or two back. The problem was of constructing a patent cervical canal and maintaining its patency permanently. The reconstructed cervix would close down despite use of intracervical stents like Foley catheters as the cervical mucosa would not regenerate or could not be created.
Over the last 2 decades many successful attempts have been made to establish permanent patency of the functional uterus to the exterior. These reconstructive plastic procedures include excision of the atretic part of the cervix and directly anastomosing the uterus to the vagina, use of bio medical grafts like amniotic membrane, vaginal mucosa, porcine small intestine submucosa, patients' own colon and even full thickness skin graft. Stents used were Foley catheters, silicone stents and polytetrafluroethylene Gore-Tex stents.
Some patients have isolated cervical atresias but a patent vagina. The other category which poses greater management challenge is that of an adolescent with cervical atresia and vaginal aplasia. In such cases there is a need to not only establish patency of the uterus to the exterior but also perform a vaginoplasty to establish a functional vagina.
The various methods attempted to restore functional and reproductive capability of these individuals include cervical drilling and canalization procedures, uterovaginal anastomosis, uterovestibular anastomosis, uterocolonocovaginoplasty performed either through a standard laparotomy or laparoscopically. Anastomosis are preferred over canalization procedures even though they are easy to perform as the incidence of re-stenosis is very high (40-60 % ) with drilling and canalization procedures. This results in multiple repeat surgeries, increased morbidity and eventually leads to a hysterectomy.
In patients with only cervical atresia, or associated vaginal aplasia successful restoration of menstrual, sexual and reproductive function have been reported in numerous studies by various authors by performing uterovaginal anastomosis or uterovestibular anastomosis. Restenosis, infections are real morbidities which still require hysterectomy.
These procedures are usually performed in a semi-lithotomy position to allow concurrent abdominal and vaginal procedure. After these procedures patients have good vaginal depth for sexual function and pregnancies have been reported naturally or after use of assisted reproductive techniques. All patients who have delivered have delivered by elective cesarean section. No vaginal births have been reported. Since the procedure of uterovaginal anastomosis or uterovestibular anastomosis involves incising the uterine fundus elective prelabor cesarean section is safer for childbirth.Reviewing the literature, studying the treatment options and noting the success rate of the uterovaginal anastomosis procedures it is heartening to see that an option for conservative treatment is a reality for the adolescent girl with cervical atresia. Early diagnosis, desire to save the uterus, restore menstrual, sexual and reproductive function either spontaneous or with assisted reproductive techniques, opting for uterovaginal anastomosis as the 1st line of treatment can change the grim outlook for these adolescent girls who are standing at the brink of their womanhood and save them from a hysterectomy.