CPT® Code 57291

1. Indications

The construction of an artificial vagina using CPT® Code 57291 is indicated for the treatment of congenital absence of the vagina. This condition may arise from various congenital anomalies, most notably Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, where individuals are born with an underdeveloped or absent vagina and, in some cases, a uterus. The procedure is performed to create a functional vaginal canal, which is essential for sexual intercourse and may also be necessary for gynecological health.

• Congenital Absence of the Vagina This procedure is specifically indicated for individuals diagnosed with congenital conditions that result in the absence or underdevelopment of the vagina.

2. Procedure

The procedure for the construction of an artificial vagina without a graft involves several critical steps that ensure the successful creation of a vaginal canal.

• Step 1: Incision An H-shaped incision is made between the urethra and rectum. This incision is strategically placed to allow access to the tissues necessary for creating the vaginal cavity.
• Step 2: Blunt Dissection Using blunt dissection techniques, a cavity is carefully created. This step is crucial as it forms the space that will become the new vaginal canal.
• Step 3: Cavity Creation If a functioning uterus is present, the cavity is extended up to the lowest pole of the uterine cavity. In cases where the uterus is absent, the cavity is created up to the peritoneum, ensuring that the new canal is appropriately sized and positioned.
• Step 4: Insertion of Sound A sound is inserted into the uterus, if applicable, to help maintain the correct alignment and patency of the newly formed canal.
• Step 5: Bleeding Control Electrocoagulation is employed to control any bleeding that may occur during the procedure, ensuring a safer surgical environment.
• Step 6: Placement of Vaginal Stent A vaginal stent is placed in the newly created cavity to maintain its structure and prevent closure during the healing process.
• Step 7: Foley Catheter Insertion A Foley catheter may be inserted into the uterus to help maintain the patency of the cervical canal, further supporting the healing process.
• Step 8: Suturing Sutures are placed in the labial musculature to temporarily secure the vaginal stent in place until the surgical wound has healed adequately.

3. Post-Procedure

After the construction of the artificial vagina, patients will require careful post-procedure care to ensure proper healing and function of the newly created canal. Patients are typically monitored for any signs of complications, such as infection or excessive bleeding. The vaginal stent will remain in place for a specified period to support the structure of the new canal. Patients may also need to follow specific instructions regarding hygiene and activity levels during the recovery phase. Follow-up appointments will be necessary to assess healing and to determine when it is appropriate to remove the stent and resume normal activities. Additionally, patients may be educated on the importance of regular gynecological examinations to monitor their health following the procedure.