Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia: A Prospective Cohort Study of Surgical Outcomes and Follow-Up of 42 Patients.
BACKGROUND
In young transgender women previously treated with puberty-suppressing hormones, penoscrotal hypoplasia can make penoscrotal inversion vaginoplasty unfeasible. The aim of this study was to prospectively assess surgical outcomes and follow-up of total laparoscopic sigmoid vaginoplasty as primary reconstruction in a cohort of transgender women with penoscrotal hypoplasia.


METHODS
Baseline demographics, surgical characteristics, and intraoperative and postoperative complications of all performed total laparoscopic sigmoid vaginoplasty procedures were prospectively recorded.


RESULTS
From November of 2007 to July of 2015, 42 transgender women underwent total laparoscopic sigmoid vaginoplasty as primary vaginal reconstruction. The mean age at the time of surgery was 21.1 ± 4.7 years. Mean follow-up time was 3.2 ± 2.1 years. The mean operative duration was 210 ± 44 minutes. There were no conversions to laparotomy. One rectal perforation was recognized during surgery and immediately oversewn without long-term consequences. The mean length of hospitalization was 5.7 ± 1.1 days. One patient died as a result of an extended-spectrum beta-lactamase-positive necrotizing fasciitis leading to septic shock, with multiorgan failure. Direct postoperative complications that needed laparoscopic reoperation occurred in three cases (7.1 percent). In seven cases (17.1 percent), long-term complications needed a secondary correction. After 1 year, all patients had a functional neovagina with a mean depth of 16.3 ± 1.5 cm.


CONCLUSIONS
Total laparoscopic sigmoid vaginoplasty seems to have a similar complication rate as other types of elective laparoscopic colorectal surgery. Primary total laparoscopic sigmoid vaginoplasty is a feasible gender-confirming surgical technique with good functional outcomes for transgender women with penoscrotal hypoplasia.
Therapeutic, IV.
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; and Gender Surgery Amsterdam.
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; and Gender Surgery Amsterdam.
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; and Gender Surgery Amsterdam.
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; and Gender Surgery Amsterdam.
Müjde
M
Özer
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; and Gender Surgery Amsterdam.
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; and Gender Surgery Amsterdam.
Wilhelmus J H J
WJHJ
Meijerink
D000293:Adolescent; D000328:Adult; D012809:Colon, Sigmoid / Q000637:transplantation*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D017063:Outcome Assessment, Health Care; D010413:Penis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012611:Scrotum / Q000473:pathology / Q000601:surgery*; D057829:Gender-Affirming Procedures; D057830:Gender-Affirming Surgery / Q000379:methods*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
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