Transverse vaginal septae: management and long-term outcomes

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  • Linked article: This article is a mini-commentary on Williams CE et al., pp. 1653–8 in this issue. Transverse vaginal septae: management and long-term outcomes. To view the article http://dx.doi.org/10.1111/1471-0528.12899.

This study by Williams et al., detailing 14 years of experience treating transverse vaginal septae (TVS) is the largest series published to date. Previously published data include a case series of 26 women (Rock et al. Obstet Gynecol 1982;59:448–51) and a literature review describing multiple case reports (Levy et al. Int Urogynecol J 1997;8:173–6). Not only is the size of this series favourable, but the findings reported by Williams et al. provide new postoperative outcomes data on women undergoing surgical management of TVS, as they relate to septum location, thickness, perforation and surgical approach. These findings are novel and have not been previously reported.

Several findings in this study merit additional comment. First, the location distribution of TVS differs between this study and the previously published series by Rock et al. Although this can be attributed to referral patterns or classification methods, it highlights the need for a standardised classification system for TVS. This will help to improve communication regarding these anomalies. Second, treatment of these disorders is necessary and should not be delayed. This study supports previous findings of endometriosis at the time of operative treatment (which often improves after septum resection). In women who are not amenable to surgical treatment or postoperative dilatation (if required), chemical suppression of the menstrual cycle should be instituted. Third, 30% of women in this series had already undergone previous unsuccessful surgical management (mostly incision and drainage). Of these women, nearly half required an abdomino-peritoneal resection with one-third of women re-obstructing postoperatively. These findings emphasise that the best chance of a successful surgical repair is with the first intervention. As such, referral to a tertiary-care centre specialising in the surgical treatment of congenital anomalies is recommended. Fourth, short-term outcomes for low and perforate TVS are good compared with high, thick septae, which are associated with the need for retreatment and major surgical complications like fistula. Preoperative counselling detailing outcome expectations based on septum location and thickness should be provided to the woman. Fifth, vaginal surgery may be safer and associated with fewer complications. These findings may be related to selection bias: TVS resection was performed in a nonrandomised fashion by either a vaginal or abdominal route, probably based on TVS characteristics. However, the findings are compelling enough that the risks associated with a surgical approach should be strongly considered when choosing a route of surgery. Additionally, though septum resection led to regular menses and the ability to have intercourse for a majority of women, dyspareunia and dysmenorrhoea were described by 59% and 36% of women, suggesting that perfect functional outcomes are rare. Finally, the major weakness of this study is related to design. There are inherent biases in studies that are retrospective in nature as well as those that rely on postal survey response. A prospective study designed to confirm the findings of this series would be beneficial. Because these anomalies are rare, tertiary-care centres should aim to maintain prospective databases on women with congenital anomalies to better study and share their outcomes.

Disclosure of interest

The author has no conflict of interest to disclose.

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