ABSTRACT
Congenital female genital tract anomalies are defined as deviations from the normal anatomy, resulting from embryological defects of the Mullerian or paramesonephrotic ducts. Currently, the ESHRE/ESGE classification is the most commonly used, while their surgical correction techniques are being constantly perfected. Surgical management of congenital gynecologic anomalies depends on the type of malformation, its complexity, symptoms and the patient's desire to maintain or regain fertility. Most non-severe malformations can be treated hysteroscopically, but in advanced cases laparoscopy or sometimes laparotomy is required, and in complex cases a combined approach by vaginal and laparoscopic route is necessary. When addressing utero-cervical-vaginal malformation, the objectives are restoration of the menstrual function and preservation of fertility, given the fact that we are addressing young nulliparous women. In the most severe and complex cases, the principles of reconstructive surgery must address the restoration of the continuity of the genital tract. The reconstruction may be realized using different types of grafts or continuous traction of Mullerian structures on the aplastic vagina. Our technique involves in most cases vaginal reconstruction by constant and continuous traction of Mullerian remnants. This causes the elongation of the vaginal walls, creating in time a normal length vagina. Complex utero-cervico-vaginal malformations must be treated by specialized personnel, with experience in this pathology and high surgical skills.
