A Uterus-Preserving Laparoscopic Technique for Cervicovaginal Agenesis With Functional Uterine Remnants

BACKGROUND: Cervicovaginal agenesis with functional uterine remnants is a rare Müllerian anomaly that may cause obstructed menstrual flow, pelvic pain, haematometra, haematosalpinx and endometriosis. Uterus-preserving reconstruction is challenging because it requires both neovaginal creation and durable uterine drainage. AIMS: To describe a uterus-preserving laparoscopic technique combining peritoneal pull-down neovaginoplasty with catheter-guided uterovaginal anastomosis in patients with cervicovaginal agenesis and obstructed functional uterine remnants. MATERIALS AND METHODS: Seven patients with cervicovaginal agenesis and functional uterine remnants underwent laparoscopic reconstruction between 2019 and 2024. The procedure included laparoscopic-guided vesicorectal dissection, peritoneal pull-down neovaginoplasty, opening and drainage of the obstructed uterine remnant, intrauterine Foley catheter placement and circumferential uterovaginal anastomosis. In patients with bilateral remnants, cavity unification was performed before anastomosis. Postoperative mould use and intrauterine catheterisation were used to maintain patency during healing. RESULTS: Menstrual drainage was restored in all patients. Office hysteroscopy confirmed a patent uterovaginal anastomosis and accessible endometrial cavity. No intraoperative bladder, rectal, ureteric or vascular complications occurred. One patient underwent two unsuccessful frozen embryo transfer attempts. One patient required hysterectomy for recurrent pelvic inflammatory disease, with preservation of the neovagina. No late stenosis was observed during available follow-up. DISCUSSION: This technique may provide a feasible uterus-preserving approach for selected patients with cervicovaginal agenesis and functional uterine remnants. However, the presence of an accessible cavity does not prove normal biological uterine function, implantation potential or pregnancy safety. The findings should be interpreted with caution because of the small sample size and limited reproductive follow-up. CONCLUSION: Laparoscopic peritoneal pull-down neovaginoplasty combined with catheter-guided uterovaginal anastomosis may restore menstrual drainage and anatomical patency in carefully selected patients. Further multicentre experience with objective imaging, hysteroscopic follow-up and reproductive outcome data is required to assess fertility potential, pregnancy safety and long-term durability.