Use of right colon vaginoplasty in gender affirming surgery: proposed advantages, review of technique, and outcomes
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and Other Interventional Techniques
Use of right colon vaginoplasty in gender affirming surgery: proposed advantages, review of technique, and outcomes Maurice M. Garcia1,2,3 · Wesley Shen5 · Rachel Zhu5 · Isabella Stettler5 · Michael Zaliznyak3,4 · Moshe Barnajian3,5 · Jason Cohen3,5 · Ankit Sarin6 · Yosef Nasseri3,5 Received: 19 May 2020 / Accepted: 1 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Various methods have been described to create a functional neovagina with feminizing (male-to-female) gender affirming surgery. Intestinal vaginoplasty using ileal or colon segments confers natural mucus production and greater canal depth with primary vaginoplasty. In this work we describe an alternative approach to primary and salvage vaginoplasty using right colon. We focus on relative advantages compared to use of other bowel segments, and we review patient outcomes. Methods Transgender women who had previously undergone primary vaginoplasty underwent laparoscopic right colon vaginoplasty at our center between 12/2017 and 7/2019. Demographic, medical, outcome, and satisfaction data was collected and retrospectively reviewed. Results Twenty-two consecutive transgender women patients underwent laparoscopic right colon vaginoplasty. Mean age was 39.3 years. There were two intraoperative complications:1 injury of the ileocolic pedicle, and 1 minor bladder injury. Four of 22 patients (18.2%) had short-term complications ( 30 days): 1 developed Crohn’s (not involving the neovagina); 1 developed late small bowel obstruction (SBO) (managed conservatively); 5 developed neovagina prolapse; 4 developed stenosis (2 at the vaginal introitus, and 2 had extrinsic obstruction at the recto-vaginal junction (all underwent successful laparoscopic surgical correction); and 3 were diagnosed with diversion neovaginitis (all treated conservatively). All complications were successfully treated with conservative and/or surgical intervention. All (100%) patients reported satisfaction with neovagina function and appearance. Conclusion This is the only outcomes series of transgender women patients who have undergone right colon vaginoplasty, to date. Our study finding suggests that laparoscopic right colon for primary or salvage vaginoplasty has several important advantages over use of Sigmoid colon or Ileum, and is a reliable technique whose complications can be managed successfully, with favorable, satisfactory long-term outcomes. Keywords Right colon · Vaginoplasty · Transgender · Prolapse · Stenosis · Diversion neovaginitis Today approximately 0.6–0.7% of the U.S. population (1.4–1.65 million) identifies as transgender. The majority of transgender adults seeking gender affirming surgery report their first experience of gender dysphoria before age 7 [1].
While it is not known what proportion of these elect genital gender affirming surgery, estimates suggest that this number is significant [2]. Vaginoplasty as a feminizing (maleto-female) gender affirming surgery was first int
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