V8-01: USE OF BOWEL FOR VAGINOPLASTY IN MALE TO FEMALE TRANSSEXUAL
VideoIntroductions and Objectives
The surgical management of neovaginal stenosis in a transsexual patient is a complex problem and constitutes a significant technical challenge. Where a primary vaginoplasty yields unsatisfactory functional results, a secondary vaginoplasty using intestinal segments represents an elegant means to achieve vaginal reconstruction. In this video we present our surgical techniques of vaginoplasty by using sigmoid colon and ileum.
Since 2006, 19 patients aged from 23 to 41 years (mean 33 years) came to our observation for neovaginal stenosis. Sigmoid colon was utilized in 8 cases, while ileum in 11.
The mean operating time was 220 min (range 185–250). No intra-operative complication occurred. Post-operative pain was minimal and the course was uneventful: only one patient had a urinary tract infection. The mean hospital stay was 8.6 days (range 7–11). The median follow-up of this series was 18 months (range, 9 months to 4.1 years). All patients had transient vaginal discharge which resolved within 6 months. The mean length of the neovagina at the first postoperative control was 12 cm (range 10.5–14 cm).
Use of sigmoid colon is usually the first line option for vaginal reconstruction due to anatomical proximity and easy mobilization of the vascular pedicle of this part of the bowel. Other advantages of using sigmoid segments include the limited need for dilatations in the post-operative period, the relatively stronger resistance of the mucosa to trauma and the ability of the intestinal mucus to act as lubrifier. Vaginoplasty by the use of an ileal segment is another possible option. There are several reasons to prefer ileum instead of sigmoid colon. First of all, ileum is technically the least difficult of conduits to create and this is why, it has become the segment of choice in conduit diversion in urological practice. Secondly ileum has a lower mucus production as compared to large bowel.