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Minimally Invasive Endoscopic Approach for Management of OHVIRA Syndrome

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Abstract

Background

Herlyn–Werner–Wunderlich syndrome is an uncommon entity characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis (also called OHVIRA syndrome). Due to rarity and varied presentations, often correct diagnosis is missed out during work up, leading to management problems. We describe our dependence on detailed preoperative work up and minimally invasive endoscopic approach in management of the eight patients of OHVIRA syndrome.

Methods

In this retrospective case series study, eight patients of OHVIRA syndrome were managed from January 2012 to March 2018 with the help of improved imaging facility and diagnostic work up. Precise diagnosis helped in adopting minimally invasive approach in management. Patients were reviewed, focusing on presentation, radiologic findings and surgical management.

Results

Median age at diagnosis was 19 years (range 13–41 years). Abdominal pain and dysmenorrhea were the main presenting complaint. All patients except one had associated ipsilateral renal agenesis. Surgical excision of the obstructed hemivaginal septum and hematometra drainage was the main treatment. In seven patients, vaginoscopic resection of vaginal septum was done with resectoscope except one 41-year-old patient, where resection of vaginal septum was performed laparoscopically along with hysterectomy.

Conclusion

Vaginoscopic resection of obstructed hemivaginal septum is an effective method. Management has shifted to minimally invasive approach due to improved imaging, precise preoperative diagnosis and proper understanding of the disease.

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Authors and Affiliations

  1. Paras Hospital, Gurgaon, India

    Alka Kriplani

  2. Mahendru Hospital, New Delhi, India

    Venus Dalal

  3. Obstetrics and Gynaecology Department, AIIMS, New Delhi, India

    Garima Kachhawa, Reeta Mahey, Vikas Yadav & Isha Kriplani

Authors
  1. Alka Kriplani
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  2. Venus Dalal
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  3. Garima Kachhawa
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  4. Reeta Mahey
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  5. Vikas Yadav
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  6. Isha Kriplani
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Corresponding author

Correspondence to Venus Dalal.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from patient for being included in the study.

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Dr. Alka kriplani, M.D. Obstetrics and Gynaecology, Consultant at Paras Hospital, Gurgaon. She was a former professor and head of department of obstetrics and gynaecology, AIIMS, New Delhi. Dr. Venus Dalal, M.D. Obstetrics and gynaecology, Consultant at Mahendru Hospital, New Delhi (former senior resident, AIIMS). Dr. Garima Kachhawa, M.D. Obstetrics and gynaecology, Associate professor at Obstetrics and Gynaecology department, AIIMS, New Delhi. Dr. Reeta Mahey, M.D. Obstetrics and Gynaecology, Associate professor at Obstetrics and gynaecology department, AIIMS, New Delhi. Dr. Vikas Yadav, M.D. Obstetrics and Gynaecology, Senior resident at Obstetrics and Gynaecology Department, AIIMS, New Delhi. Dr. Isha Kriplani, M.D. Obstetrics and Gynaecology, Senior resident at Obstetrics and Gynaecology Department, AIIMS, New Delhi.

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Kriplani, A., Dalal, V., Kachhawa, G. et al. Minimally Invasive Endoscopic Approach for Management of OHVIRA Syndrome. J Obstet Gynecol India 69, 350–355 (2019). https://doi.org/10.1007/s13224-019-01240-4

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  • DOI: https://doi.org/10.1007/s13224-019-01240-4

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