Revision Vaginoplasty: A Comparison of Surgical Outcomes of Laparoscopic Intestinal versus Perineal Full-Thickness Skin Graft Vaginoplasty.
BACKGROUND
Vaginal (re)construction can greatly improve the quality of life of indicated patients. If primary vaginoplasty fails, multiple surgical approaches exist for revision. The authors compared surgical results of laparoscopic intestinal versus full-thickness skin graft revision vaginoplasty.


METHODS
A retrospective chart review of patients who underwent revision vaginoplasty at the authors' institution was conducted. Patient demographics, surgical characteristics, complications, hospitalization, reoperations, and neovaginal depth for both surgical techniques were recorded and compared.


RESULTS
The authors studied a consecutive series of 50 transgender and three biological women who underwent revision vaginoplasty, of which 21 were laparoscopic intestinal and 32 were perineal full-thickness skin graft vaginoplasties, with a median clinical follow-up of 3.2 years (range, 0.5 to 19.7 years). Patient demographics did not differ significantly. There was no mortality. Two intraoperative rectal perforations (10 percent) occurred in the intestinal group versus six (19 percent) in the full-thickness skin graft group. Operative time was shorter for the full-thickness skin graft vaginoplasty group (131 ± 35 minutes versus 191 ± 45 minutes; p < 0.01). Hospitalization length did not differ significantly. Successful vaginal (re)construction was achieved in 19 intestinal (91 percent) and 26 full-thickness skin graft (81 percent) vaginoplasty procedures. A deeper neovagina was achieved with intestinal vaginoplasty (15.9 ± 1.4 cm versus 12.5 ± 2.8 cm; p < 0.01).


CONCLUSIONS
Both laparoscopic intestinal and full-thickness skin graft vaginoplasty can be used as secondary vaginal reconstruction. Intraoperative and postoperative complications do not differ significantly, but rectal perforation was more prevalent in the full-thickness skin graft vaginoplasty group. Although the operative time of laparoscopic intestinal vaginoplasty is longer, adequate neovaginal depth was more frequently achieved than in secondary perineal full-thickness skin graft vaginoplasty.


METHODS
Therapeutic, III.
Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the EMGO Institute for Health and Care Research, the Center of Expertise on Gender Dysphoria, and the Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center.
Wouter B
WB
Van der Sluis
Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the EMGO Institute for Health and Care Research, the Center of Expertise on Gender Dysphoria, and the Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center.
Mark-Bram
MB
Bouman
Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the EMGO Institute for Health and Care Research, the Center of Expertise on Gender Dysphoria, and the Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center.
Marlon E
ME
Buncamper
Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the EMGO Institute for Health and Care Research, the Center of Expertise on Gender Dysphoria, and the Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center.
Margriet G
MG
Mullender
Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the EMGO Institute for Health and Care Research, the Center of Expertise on Gender Dysphoria, and the Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center.
Wilhelmus J
WJ
Meijerink
D000328:Adult; D012809:Colon, Sigmoid / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D010535:Laparoscopy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012086:Reoperation; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D016038:Skin Transplantation; D014621:Vagina / Q000601:surgery*
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