(35) Estimated blood loss and safety by technique for longitudinal vaginal septum excision

Background: Longitudinal vaginal septum (LVS) is a congenital anomaly that may be excised in adolescents with symptoms such as tampon difficulty. Several techniques for surgical excision exist, including excision with cautery or a bipolar electrosurgical instrument. Our study objective was to evaluate if any difference in blood loss or postoperative complications existed between excision with Bovie® cautery versus with the LigaSure™ vessel sealing device. We hypothesized that blood loss and complications were low with both surgical techniques.

Methods: This was a retrospective study of all patients who underwent LVS excision at a single pediatric tertiary care institution under the care of the Pediatric and Adolescent Gynecology division from 2012 to 2024. Patients either underwent excision using cautery or a vessel sealing device; the vaginal mucosa was oversewn after either technique. Demographics, clinical characteristics, estimated blood loss, and postoperative complications were abstracted from the medical chart. This study was approved by the Institutional Review Board.

Results: 44 patients underwent excision of LVS during the study time period, mean age 17 years. The most common presenting symptom was tampon difficulty (52%) followed by dysmenorrhea (39%), and dyspareunia (9%). Eleven percent had no symptoms reported. The majority of patients (84%) had 2 cervices; 7 (16%) had 1 cervix. Thirty-two patients (73%) underwent cautery, 11 (25%) underwent vessel sealing, and 1 (2%) both. Mean blood loss was not significantly different with both techniques (13 vs. 4 ml, p=.10). Postoperative complications were rare. 7 (16%) patients presented to the emergency department (ED), average 12 days post-surgery. Of these 7 patients, 3 presented for vaginal bleeding, 1 for vaginal discharge, 3 for symptoms deemed unrelated to surgery by the ED. One patient underwent emergent revision due to an estimated 400 ml blood loss prior in the ED, with 100 ml blood evacuated in the OR and 10 ml active blood loss with the revision. Of the 3 patients who presented to the ED for bleeding concerns, 2 underwent cautery, and 1 underwent vessel sealing device.

Conclusions: The overall blood loss at time of surgery for LVS was low and did not significantly differ by surgical technique, although there was a trend towards less blood loss with vessel sealing that might become significant with a larger sample. Postoperative complications were also rare with either method, though 2 patients (4%) experienced unanticipated problems – one significant interoperative tissue friability and the other bacterial vaginosis. Surgeons may consider using several techniques to safely perform LVS excision.