Laparoscopic Davydov vs. laparoscopic Vecchietti neovaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome; a systematic review and meta-analysis

IMPORTANCE AND OBJECTIVE: To summarize available evidence on the laparoscopic Davydov and Vecchietti method to create a neovagina and to compare these techniques with focus on neovaginal length, sexual function, operative time, and complications. DATA SOURCES: A systematic electronic search up till August 2022 using Pubmed and Embase is performed. STUDY SELECTION AND SYNTHESIS: All published clinical studies concerning the laparoscopic Davydov and laparoscopic Vecchietti procedure as a surgical technique to create a neovagina in women with MRKH syndrome are obtained. The PRISMA guidelines are followed. The following data are extracted: operative time, hospital stay, major early complications (within 3 months post-surgery), dilation therapy, neovaginal length, vaginal discharge, vaginal stenosis, time to sexual activity, sexual satisfaction, penetrative sexual activity, dyspareunia, score on the Female Sexual Function Index (FSFI), and duration of follow-up. The Newcastle Ottawa Scale is used to access the quality of articles. MAIN OUTCOMES: neovaginal length, FSFI scores, operative time, complications RESULTS: A total of 1163 articles are identified of which 31 studies are included in this systematic review. Of these, 12 studies (380 patients) are related to the Davydov method, 17 studies (804 patients) to the Vecchietti method and 2 article concerns both. There is clinical heterogeneity and variety in quality of the studies. Nineteen studies are included in the meta-analyses. The mean neovaginal length 12 months after the Davydov method is 8.3 cm (95%CI 8.1-8.6), versus 8.7 cm (95%CI 7.2-10.3) after the Vecchietti method. The mean FSFI score after the Davydov method is 28.9 (95%CI 26.8-31.1), compared to 27.5 (95%CI 25.0-30.1) after the Vecchietti method. The operative time of the Davydov method is 126 minutes (95%CI 109-143) compared to 40 minutes (95%CI 35-45) of the Vecchietti method. CONCLUSION AND RELEVANCE: The operations yield comparable neovaginal length, sexual function, and complication rate. The mean FSFI scores indicate no sexual dysfunction in either group. The operative time of the Davydov method is significantly longer. There is no superiority shown for one of the surgical techniques in functional terms.