Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery.

Resection of the inferior vena cava may be required in the courses of oncological surgeries for the tumors originating from or invading it. Management of the remaining defect depends on the extension of the resection. Partial or complete replacement of the inferior vena cava, with a patch or interposition graft, may be required. Standard techniques for the reconstruction with a prosthetic material or the autologous veins can be associated with the prosthetic graft infection, high cost, long-standing anticoagulation, technical difficulties, and/or need for extra incisions. The use of the autologous peritoneum represents an easy and inexpensive alternative for the partial and complete inferior vena cava reconstructions.

Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence?

BACKGROUND: To optimize neovaginal dimensions, several modifications of the traditional penile inversion vaginoplasty are described. Options for neovaginal lining include skin grafts, scrotal flaps, urethral flaps, and peritoneum. Implications of these techniques on outcomes remain limited. METHODS: A systematic review of recent literature was performed to assess evidence on various vaginal lining options as adjunct techniques in penile inversion vaginoplasty. Study characteristics, neovaginal depth, donor-site morbidity, lubrication, and complications were analyzed in conjunction with expert opinion. RESULTS: Eight case series and one cohort study representing 1622 patients used additional skin grafts when performing penile inversion vaginoplasty. Neovaginal stenosis ranged from 1.2 to 12 percent, and neovaginal necrosis ranged from 0 to 22.8 percent. Patient satisfaction with lubrication was low in select studies. Three studies used scrotal flaps to line the posterior vaginal canal. Average neovaginal depth was 12 cm in one study, and neovaginal stenosis ranged from 0 to 6.3 percent. In one study of 24 patients, urethral flaps were used to line the neovagina. Neovaginal depth was 11 cm and complication rates were comparable to other series. Two studies used robotically assisted peritoneal flaps with or without skin grafts in 49 patients. Average neovaginal depth was approximately 14 cm, and complication rates were low. CONCLUSIONS: Skin grafts, scrotal flaps, urethral flaps, and peritoneal flaps may be used to augment neovaginal canal dimensions with minimal donor-site morbidity. Further direct comparative data on complications, neovaginal depth, and lubrication are needed to assess indications in addition to advantages and disadvantages of the various lining options.

Parietal Peritoneum as a Novel Substitute for Middle Hepatic Vein Reconstruction During Living Donor Liver Transplantation.

BACKGROUND: Although autologous, cryopreserved, or artificial vascular grafts can be used as interpositional vascular substitutes for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), they are not always available, are limited in size and length, and are associated with risks of infection. This study aimed to evaluate the parietal peritoneum as a novel substitute for MHV reconstruction during LDLT. METHODS: Prospectively collected data of 15 patients who underwent LDLT using the right liver with reconstruction of MHV using the recipients' own parietal peritoneum graft were retrospectively reviewed. RESULTS: The 1-, 2-, 3-, and 5-mo patency rates were 57.1%, 57.1%, 57.1%, and 28.6%, respectively. Among the 15 cases assessed, the most recent 6 cases showed patent graft flow until discharge with 1-, 2-, 3-, and 5-mo patency rates of 80.0%, 80.0%, 80.0%, and 20.0%, respectively. All patients survived with tolerable liver function tests. There were no significant congestion-related problems, except for 1 patient who experienced MHV thrombosis requiring aspiration thrombectomy and stent insertion. There were no infection-related complications. All patients survived to the final follow-up, with a minimum follow-up duration of 8 mo. When comparing the latter 6 cases of peritoneal grafts and the recent 28 cases of conventional polytetrafluorethylene graft, the overall patency rate of the polytetrafluorethylene group was higher (P = 0.002). There were no major differences other than long-term patency rate. CONCLUSIONS: Parietal peritoneum may be a novel autologous substitute for MHV reconstruction during LDLT.

Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases.

PURPOSE: Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. METHODS: Retrospective observational study included 36 cases of open VVF repair, performed during 2010-2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O'Conor was performed and doubly folded peritoneal flap was utilized. Intra- and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of follow-up was done. RESULTS: Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. CONCLUSION: Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.

Túnica vaginal autógena para herniorrafia perineal em cães / Autogenous tunica vaginalis for perineal herniorrhaphy in dogs

A túnica vaginal possui características ideais para enxertia e já foi empregada na reparação de diversos tecidos, inclusive do diafragma pélvico. Objetivou-se avaliar a aplicabilidade da túnica vaginal como enxerto autógeno livre, em dupla camada, para a reparação do diafragma pélvico em 14 cães portadores de hérnia perineal, das quais, nove eram unilaterais e cinco, bilaterais. Após a orquiectomia, as túnicas de ambos os testículos foram coletadas, sobrepostas e fixadas entre si por meio de quatro pontos de reparo. Foi realizada abordagem ao saco herniário, inspeção, redução do conteúdo herniário, desbridamento muscular e síntese primária mediante sutura. O enxerto foi fixado à musculatura remanescente por meio de pontos simples separados e, posteriormente, encoberto pela sutura intradérmica e por síntese cutânea. Observações transoperatórias e, posteriormente, avaliações clínicas e ultrassonográficas, por período de um ano, permitiram sugerir que a túnica vaginal possui atributos ideais para a reparação do diafragma pélvico. Conclui-se que o enxerto autógeno livre de túnica vaginal, em dupla camada, é exequível e aplicável para o reparo do diafragma pélvico no tratamento da hérnia perineal em cães.(AU)

The tunica vaginalis has ideal characteristics for grafting and has already been used to repair several tissues, including the pelvic diaphragm. The aim of this study was to evaluate the applicability of the tunica vaginalis as a free double-layer autogenous graft to repair the pelvic diaphragm in 14 dogs with perineal hernia, of which, nine were unilateral and five, bilateral. After orchiectomy, the tunics of both testicles were collected, overlapped and fixed to each other by four repair points. The hernial sac was approached, followed by inspection, reduction of the hernia content, muscle debridement and primary synthesis through suture. The graft was attached to the remaining musculature by simple interrupted stitches and later hidden by intradermal suture and cutaneous synthesis. Intraoperative observations and, later, clinical and sonographic evaluations over a one-year period, allow to suggest that the tunica vaginalis has ideal attributes for the pelvic diaphragm repair. It is concluded that the autogenous graft-free of tunica vaginalis in double layer is feasible and applicable in order to repair the pelvic diaphragm in the perineal hernia treatment in dogs.(AU)

Autologous peritoneal graft for venous vascular reconstruction after tumor resection in abdominal surgery: a systematic review.

Radical surgical resection (R0) is the only option to cure patients with borderline resectable or multivisceral intraabdominal malignancies involving major vessels. Autologous peritoneal flap has been described as a safe and versatile option for vascular reconstruction, but still limited experience exists regarding its use. An extensive literature review was performed to analyze results of vascular reconstruction with an autologous peritoneal graft. Fifteen reports were found for a total of 94 patients. No cases of arterial vascular reconstruction were found. Two different types of peritoneal patch have been described, backed (APFG, 30 patients) or not backed (ANFP, 64 patients) by posterior rectus sheath. A patch type of reconstruction was adopted in 70 patients (74.5%), while a tubular reconstruction in 24 (25.5%). Postoperative mortality was 5.3% (5 cases). Graft outcomes with very heterogeneous follow-ups (7 days-47 months) were available only in 85 patients (90.4%). Among them, a graft patency was documented in 80 patients (94.1%), while a stenotic graft was reported in 5 patients (5.9%). No differences in graft outcomes were observed between the patch and tubular groups (p = 0.103), nor between the ANFP and APFG groups (p = 0.625). In reported experiences, autologous peritoneal graft seems to represent a safe and versatile option for functional restoration of venous vascular anatomy after resection, especially in operations with high risk of contamination, trauma, liver transplantation and unplanned vascular resection. Unfortunately, the data available in the literature do not make it possible to draw any evidence-based conclusions on these considerations.

Single Port and Multiport Approaches for Robotic Vaginoplasty With the Davydov Technique.

OBJECTIVE: To demonstrate the feasibility, surgical technique, and initial outcomes of robotic vaginoplasty with peritoneal flap (Davydov) technique for vaginal reconstruction. METHODS: Following appropriate preoperative patient counseling, 11 consecutive patients underwent robotic vaginoplasty with the da Vinci (Intuitive Surgical, Sunnyvale CA) multiport Xi and single port robotic platforms. Perioperative and postoperative outcomes of interest were retrospectively collected. RESULTS: Between March 2019 and October 2019, a total of 11 patients have undergone robotic vaginoplasty with peritoneal flap technique at our institution-9 using the da Vinci single port platform and 2 using the da Vinci Xi platform. Reasons for vaginoplasty included primary gender-affirming genital reconstruction, vaginal stenosis after gender confirmation surgery, and vaginal hypoplasia secondary to disorders of sexual development. Mean operative time was 267.2 ± 85.9 minutes. Initial postoperative mean vaginal depth was 13.9 ± 0.5 cm. Mean estimated blood loss was 131.8 ± 92.9 mL. Mean length of stay was 5.2 ± 0.6 days and time to return of bowel function was 1.7 ± 0.9 days. Thirty-day readmission rate was 18% (N = 2/11) with 1 patient (9%) requiring surgical revision of the neovagina. CONCLUSION: Robotic-assisted Davydov technique is a potentially applicable, efficacious, and safe method of vaginal reconstruction in cisgender and transgender individuals.

[An animal model of bladder reconstruction by autologous peritoneum transplantation].

Objective: To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum. Methods: This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition. Conclusion: In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.

PARIETAL PERITONEUM GRAFT FOR DUODENUM INJURIES IN AN ANIMAL MODEL.

BACKGROUND: Duodenal injuries and their surgical procedure cause a high morbidity and mortality. AIM: To assess the overall effectiveness of the auto-graft of peritoneum in the treatment of the perforation of the duodenum, aiming to reduce surgery time, costs, complexity and mortality. METHODS: Twelve New Zealand rabbits, ages 4-6 months, both sexes, underwent designed surgical grade III duodenal injuries that were repaired 18 h after. Rabbits were surgically treated with the proposed auto-graft of peritoneum. RESULTS: No postoperative deaths were observed; the animals presented corporal weight increase and were euthanized six months later. There was no significant difference between both groups relating to the postoperative evolution or in the histological changes. CONCLUSION: Auto-graft of the peritoneum and posterior fascia is a useful option for duodenal repair and that is worth of evaluation for humans.

Robotic Davydov Peritoneal Flap Vaginoplasty for Augmentation of Vaginal Depth in Feminizing Vaginoplasty.

PURPOSE: Penile inversion vaginoplasty is the most common procedure for genital reconstruction in transwomen. While penile inversion vaginoplasty usually provides an excellent aesthetic result, the technique may be complicated by vaginal stenosis and inadequate depth, especially in transwomen with limited penile and scrotal tissue. We describe a technique of using peritoneal flaps to augment the neovaginal apex and canal in penile inversion vaginoplasty for transwomen. MATERIALS AND METHODS: Between 2017 and 2018 we identified 41 transwomen who underwent primary penile inversion and peritoneal flap vaginoplasty. Two approximately 6 cm wide by 8 cm long peritoneal flaps were raised from the anterior aspect of the rectum and the sigmoid colon, and the posterior aspect of the bladder to create the apex of the neovagina. RESULTS: Average ± SD age of the 41 patients was 34 ± 14 years. Average procedure duration was 262 ± 35 minutes and average length of stay was 5 days. Average followup was 114 ± 79 days. At the most recent followup vaginal depth and width were measured to be 14.2 ± 0.7 and 3.6 ± 0.2 cm, respectively. The peritoneal flap added an additional 5 cm of depth beyond the length of the skin graft, forming the vaginal canal in patients with limited scrotal skin. CONCLUSIONS: Penile inversion vaginoplasty remains the gold standard for primary genital reconstruction in transwomen. Peritoneal flaps provide an alternative technique for increased neovaginal depth, creating a well vascularized apex with acceptable anticipated complications.

Parietal peritoneum graft for duodenum injuries in an animal model / Enxerto de peritônio parietal em lesão duodenal: modelo animal

ABSTRACT Background: Duodenal injuries and their surgical procedure cause a high morbidity and mortality. Aim: To assess the overall effectiveness of the auto-graft of peritoneum in the treatment of the perforation of the duodenum, aiming to reduce surgery time, costs, complexity and mortality. Methods: Twelve New Zealand rabbits, ages 4-6 months, both sexes, underwent designed surgical grade III duodenal injuries that were repaired 18 h after. Rabbits were surgically treated with the proposed auto-graft of peritoneum. Results: No postoperative deaths were observed; the animals presented corporal weight increase and were euthanized six months later. There was no significant difference between both groups relating to the postoperative evolution or in the histological changes. Conclusion: Auto-graft of the peritoneum and posterior fascia is a useful option for duodenal repair and that is worth of evaluation for humans.

RESUMO Racional: Lesões duodenais e seu procedimento cirúrgico causam alta morbimortalidade. Objetivo: Avaliar a eficácia geral de retalho peritoneal no tratamento da perfuração do duodeno, visando reduzir o tempo, os custos, a complexidade e a mortalidade cirúrgicas. Métodos: Doze coelhos da raça Nova Zelândia, com idades entre 4-6 meses, ambos os sexos, foram submetidos a lesões duodenais cirúrgicas de grau III, que foram reparadas 18 h depois. Coelhos foram tratados cirurgicamente com a proposta de auto-enxerto de peritônio. Resultados: Não foram observados óbitos pós-operatórios; os animais apresentaram aumento de peso corporal e foram eutanasiados seis meses depois. Não houve diferença significativa entre os dois grupos em relação à evolução pós-operatória ou nas alterações histológicas. Conclusão: A auto-enxertia do peritônio e da fáscia posterior é uma opção útil para o reparo duodenal e vale a pena ser avaliada em seres humanos.

Enhanced Vascular Biocompatibility and Remodeling of Decellularized and Secured Xenogeneic/Allogeneic Matrices in a Porcine Model.

BACKGROUND/PURPOSE: Calcifications and absence of growth potential are the major drawbacks of glutaraldehyde-treated prosthesis. Decellularized and secured xeno-/allogeneic matrices were assessed in a preclinical porcine model for biocompatibility and vascular remodeling in comparison to glutaraldehyde-fixed bovine pericardium (GBP; control). METHODS: Native human (fascia lata, pericardium) and porcine tissues (peritoneum) were used and treated. In vitro, biopsies were performed before and after treatment to assess decellularization (hematoxylin and eosin/DAPI). In vivo, each decellularized and control tissue sample was implanted subcutaneously in 4 mini-pigs. In addition, 9 mini-pigs received a patch or a tubularized prosthesis interposition on the carotid artery or abdominal aorta of decellularized (D) human fascia lata (DHFL; n = 4), human pericardium (DHP; n = 9), porcine peritoneum (DPPt; n = 7), and control tissue (GBP: n = 3). Arteries were harvested after 1 month and subcutaneous samples after 15-30 days. Tissues were processed for hematoxylin and eosin/von Kossa staining and immunohistochemistry for CD31, alpha-smooth muscle actin, CD3, and CD68. Histomorphometry was achieved by point counting. RESULTS: A 95% decellularization was confirmed for DHP and DPPt, and to a lower degree for DHFL. In the subcutaneous protocol, CD3 infiltration was significantly higher at day 30 in GBP and DHFL, and CD68 infiltration was significantly higher for GBP (p < 0.05). In intravascular study, no deaths, aneurysms, or pseudoaneurysms were observed. Inflammatory reaction was significantly higher for DHFL and GBP (p < 0.05), while it was lower and comparable for DHP/DPPt. DHP and DPPt showed deeper recellularization, and a new arterial wall was characterized. CONCLUSIONS: In a preclinical model, DPPt and DHP offered better results than conventional commercialized GBP for biocompatibility and vascular remodeling.

Right Trisectionectomy and Caval Reconstruction with Peritoneal Patch Under Short Total Vascular Exclusion for Hepatocellular Carcinoma with Tumoral Thrombus in Suprahepatic Vena Cava.

BACKGROUND: Hepatocellular carcinoma (HCC) can be complicated by major vascular invasion, and resection can be beneficial in some patients.1 Some of these patients are traditionally operated under total vascular exclusion (TVE), refrigeration, extracorporeal circulatory bypass, and cardiac surgery, with high morbidity and mortality.2 However, HCC thrombi are not adherent to the venous wall, and with advances in surgical techniques, resection can be simplified and performed during short-duration TVE alone. Patients who need resection under any degree of TVE represent < 5% of our hepatectomies. PATIENT AND METHODS: A 59-year-old male patient was admitted for management of a right large HCC (developed on a metabolic syndrome without cirrhosis). After 12 months of treatment, HCC progressed after arterial chemoembolization followed by antiangiogenic treatment, with tumoral thrombus extension to the intrathoracic vena cava up to the right atrium. Surgical resection under TVE and intrathoracic control of the vena cava was decided. Liver transection was performed with intermittent clamping of the hepatic pedicle and low central venous pressure. During 25 min of TVE and vascular remplissage, resection was completed with complete thrombectomy and reconstruction of the vena cava with a peritoneal patch.3 RESULTS: Surgery lasted 330 min, with blood loss of 500 ml and transfusion of 2 units of blood. Postoperative course was uneventful with 10-day hospital stay. Four months after resection, the patient is well with no disease recurrence. CONCLUSION: As surgical techniques improve, complicated liver resection can be performed during short-duration total vascular exclusion.

Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament.

BACKGROUND: With the improvement of the surgical technique of Laparoscopic pancreaticoduodenectomy (LPD), indications will be extended to patients with vascular invasion. With LPD, vascular grafts for reconstruction are more frequently needed because adequate mobilization is not always done and vascular grafts can safely facilitate reconstruction. We describe our experience of reconstruction with the falciform ligament. METHODS: Venous reconstruction is performed after removal of the specimen. The falciform ligament is rapidly harvested within the same surgical field and for any size and used for lateral reconstruction of the mesentericoportal vein. Therapeutic anticoagulation is not needed and venous patency was assessed by postoperative CT scan. Since April 2011 and among the 93 patients who underwent LPD, four patients had this procedure. RESULTS: The mean age was 73 years old (69-77) and 3 were women. Indications for resection were pancreatic adenocarcinoma (n = 3) and IPMN in severe dysplasia (n = 1) and the mean patch size of 13 mm (10-30). The mean operative time was 397 min (330-480); vascular clamping lasted 54 min (45-60), and mean blood loss was 437 ml (150-1000) and one was transfused. Resection was R0 in patients with adenocarcinoma (n = 3). The postoperative course was uneventful in 3 patients and one patient was re-operated for bile leak and partial venous thrombosis and redo venous reconstruction was done. Complete venous patency was demonstrated in patients (n = 2) who still alive 1 year after resection. CONCLUSION: Venous resection will be more frequently done with LPD and vascular grafts more frequently needed. Compared to other available vascular grafts (autogenous, synthetic, cadaveric and bovine pericardium, etc), the parietal peritoneum had the advantages of being rapidly available, easy to harvest by the laparoscopic approach, not expensive, no need for anticoagulation and at lower risk of infection.

Autologous peritoneal grafts permit rapid reperitonealization and prevent postoperative abdominal adhesions in an experimental rat study.

BACKGROUND: Reperitonealization has attracted increasing attention for its potential to prevent postoperative abdominal adhesions and subsequent related complications. We studied the effect of an autologous peritoneal graft on reperitonealization and prevention of adhesions in a rat model. METHODS: A standardized peritoneal lesion was induced on the parietal peritoneum by electrocoagulation and sutures. Twenty adult rats sustaining these lesions were randomized to 1 of 4 groups: (1) autologuous peritoneal graft with the side of mesothelial cells exposed to the abdominal cavity; (2) autologuous peritoneal graft with the side of subserosa containing fibroblasts exposed to the abdominal cavity; (3) cell sheet consisting of autologuous mesothelial cells and fibroblasts; or (4) nontreated group (Control). Fourteen days after the operation, abdominal adhesions were evaluated by macroscopic observation and histologic assessment. RESULTS: Macroscopic observation revealed that in mesothelial cells/fibroblasts grafts, there was no adhesion on the surface of the peritoneal graft covering the lesion. In contrast, in the other 3 groups, all rats obviously revealed extended and severe adhesions. Histology showed that mesothelial cells exist on the surface of the graft in mesothelial cells/fibroblasts graft, but no mesothelial cells were observed in the samples from the other groups. CONCLUSION: Autologous peritoneal grafts prevented postoperative abdominal adhesions in this rat model. As the mechanism of this prevention, the mesothelial cells survived and contributed to reperitonealization, only when they were transplanted as a part of the autologous peritoneal grafts and were located on the surface exposed to the abdomen.

The Use of Autologous Peritoneum for Complete Caval Replacement Following Resection of Major Intra-abdominal Malignancies.

OBJECTIVE: Assessment of a simple layer peritoneal tube used as an autogenous inferior vena cava replacement. BACKGROUND: Extensive en-bloc multivisceral resection including major vessels is effective in selected abdominal malignancies, but the need for vascular reconstruction represents a surgical challenge. We describe the use of autologous peritoneum for caval replacement. METHODS: Autogenous parietal peritoneum without fascial backing was harvested and tubularized to replace the inferior vena cava (IVC) in four patients with complex abdominal tumors. Surgical morbidity was evaluated using the Clavien-Dindo classification, and graft patency was systematically evaluated with ultrasound. RESULTS: All four patients had multiorgan resections for malignancies involving the retro-hepatic IVC, and they all required the replacement of infrarenal and suprarenal IVC segments. Additionally, all four required a right nephrectomy, two had a combined major hepatectomy, and one patient needed a veno-venous bypass. All had an R0 resection. A clinical follow-up took place between 5 and 11 months after surgery for each patient. Four-month graft patency was confirmed by ultra-sound and TDM with no sign of disease recurrence. CONCLUSIONS: Autologous peritoneum without fascial backing is a good and safe option for circumferential replacement of IVC after extensive en-bloc tumor resection with IVC involvement.

Microinvasive squamous carcinoma of neovagina created with peritoneal flap (Davidov): Case report and literature review.

Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.