Partial and total vaginectomy refer to procedures in which the vaginal epithelium is removed without disruption of the adjacent tissues of the paracolpium. The most common indication for these procedures is treatment of vaginal intraepithelial neoplasia. Rarely, chronic benign conditions such as lichen planus may be severe enough to warrant vaginectomy. Partial vaginectomy may also be utilized to biopsy large vaginal lesions of unknown etiology. Radical vaginectomy is performed for pelvic malignancy involving or encroaching upon the vagina. It is rarely indicated. More commonly, at the time of radical hysterectomy for early cervix cancer or endometrial cancer involving the cervix, the upper third (2 to 3 cm) of the vagina is removed with some adjacent paracolpium.
Vaginectomy is reviewed here. Conditions for which vaginectomy is indicated are discussed separately. (See "Vaginal cancer" and "Vaginal intraepithelial neoplasia" and "Vulvar lichen planus".)
PARTIAL OR TOTAL VAGINECTOMY
Preoperative preparation — The procedure should be clearly explained to the patient and her partner, particularly with regard to complications. The issue of vaginal reconstruction should also be raised, depending upon the amount of vagina to be removed. Thorough bowel preparation is mandatory for more extensive vaginal surgery in case of injury to the rectum or anus. (See "Overview of preoperative evaluation and preparation for gynecologic surgery", section on 'Bowel preparation'.)
Operative procedure — General, epidural, or spinal anesthesia is administered. The patient may be placed in lithotomy position if the only approach is via the perineum and vaginal reconstruction is not planned. For all other procedures, the patient is placed in a modified frog leg position in Allen stirrups.
A total abdominal or vaginal hysterectomy is usually performed concurrently in women with an intact uterus who require total vaginectomy or upper partial vaginectomy. If two surgeons are available, a combined abdominoperineal approach facilitates the surgery. For women who have previously undergone hysterectomy, it is possible to perform total vaginectomy entirely from below. Great care must be taken to include all vaginal skin in the angles and vault of the vagina.