title: Long-Term Outcomes of Rectosigmoid Neocolporrhaphy in Male-to-Female Gender Reassignment Surgery.
abstract: BACKGROUND
  Favorable outcomes of rectosigmoid neocolporrhaphy have previously been reported. Unfortunately, rectosigmoid transfers are still perceived negatively, usually relegated to secondary vaginoplasties. This study aims to provide an objective investigation into the safety and efficacy of rectosigmoid neocolporrhaphy for vaginoplasty in male-to-female transsexual patients.
  
  
  METHODS
  A retrospective review was performed on male-to-female patients who had undergone rectosigmoid neocolporrhaphy performed by the senior author. Patient data including demographics, medical history, complications, and the need for revision surgery were obtained. Direct inquires were conducted to determine patients' level of satisfaction with appearance, sexual function, and ease of postoperative recovery.
  
  
  RESULTS
  Eighty-three patients were included over the course of 22 years, with an average clinical follow-up of 2.2 years (83 patients) and phone interview follow-up of 23 years (21 patients). Overall, the patients were healthy, with minimal comorbidities. Forty-eight patients (58 percent) had complications, but the majority (83.3 percent) were minor and consisted mainly of introital stricture or excessive protrusion of the corpus spongiosum. Smoking was associated with higher complication rates (p = 0.05), especially stricture formation. Excessive mucorrhea occurred in 28.6 percent but resolved after the first year. Overall patient satisfaction with appearance and sexual function was high.
  
  
  CONCLUSIONS
  This study is one of the largest and longest reported series of rectosigmoid transfers for vaginoplasty in transsexual patients. Rectosigmoid neocolporrhaphies have many times been recommended for secondary or revision surgery when other techniques, such as penile inversion, have failed. However, the authors believe the rectosigmoid transfer is safe and efficacious, and it should be offered to male-to-female patients for primary vaginoplasty.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Stanford, Calif.; and Chicago, Ill. From Stanford University School of Medicine; the Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center; and Northwestern University Feinberg School of Medicine.
authors.forename: Shane D
authors.initials: SD
authors.lastname: Morrison
authors.forename: Thomas
authors.initials: T
authors.lastname: Satterwhite
authors.forename: David W
authors.initials: DW
authors.lastname: Grant
authors.forename: Johanna
authors.initials: J
authors.lastname: Kirby
authors.forename: Donald R
authors.initials: DR
authors.lastname: Laub
authors.forename: Judy
authors.initials: J
authors.lastname: VanMaasdam
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000009:adverse effects / Q000379:methods*; D019738:Surgically-Created Structures; D013997:Time Factors; D014189:Transsexualism / Q000601:surgery*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D055815:Young Adult