Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

Abstract

Background: Gender-affirming surgery is classically done using the penile inversion vaginoplasty technique, however in some patients it may not promote adequate depth. In patients whose vaginal conduits became short or stenotic, we propose to perform a secondary vaginoplasty using an abdominal free skin mesh graft. In this study, we present ours results of a series of cases using this technique.Methods: A retrospective review of patients undergoing secondary vaginoplasty with free skin mesh graft from 2000 to 2017 at our hospital was performed. Demographic data, surgical characteristics, complications, personal satisfaction and neovagina functionality (defined as the ability to have satisfactory sexual intercourse) were evaluated.Results: Of 186 patients who were submitted to primary vaginoplasty, 36 patients (19.3%) were then submitted to secondary vaginoplasty. This study sample included 35 patients. The average age of patients was 41.0 years (37.0 to 50.5) and the average time between gender affirmation surgery and secondary vaginoplasty was 6 months (4-24). Ten patients (28.6%) developed postoperative complication, the most frequent being: neovagina introitus stenosis (22.9%), rectal fistula (8.6%), tissue dehiscence (2.9%), and urethral fistula (2.9%). Subjective personal satisfaction and neovagina functionality of patients was reported by 77.1% of the sample.Conclusions: Our study demonstrates that secondary vaginoplasty surgery using a free skin mesh graft has good results and is a functional option with low complexity and low rate of serious complications.

Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review

“…Following abstract screening, 98 articles underwent full-text review and assessment in accordance with the inclusion/exclusion criteria. Following final review, a total of 34 studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], encompassing n = 5064 patients, were included in the final analysis. Figure 1 shows the PRISMA flow diagram.…”

“…A total of 12 studies (35.3%) [ 17 , 18 , 19 , 21 , 29 , 31 , 32 , 33 , 34 , 35 , 39 , 46 ] were from lower-middle-income countries and 22 studies (64.7%) [ 16 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 ] were from upper-middle-income countries. No studies originated from low-income countries.…”

“…The mean patient age was 30 years (absolute range: 24.4–41.0). A total of 16 (47.1%) studies included patients’ medical histories [ 16 , 17 , 20 , 21 , 22 , 23 , 29 , 31 , 38 , 39 , 40 , 41 , 44 , 46 , 47 , 49 ] and 31 (91.2%) reported on post-operative outcomes [ 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The mean post-operative follow-up was 48 months (absolute range: 6–94 months).…”

“…While 55.8% (n = 19/34) of studies [ 16 , 17 , 19 , 20 , 22 , 23 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 35 , 43 , 44 , 45 , 46 ] included patients who underwent feminizing GAS, the total number of TGNB individuals who underwent feminizing GAS (n = 1480/5064, 29.2%) was significantly lower than of those who underwent masculinizing GAS. The distribution of the feminizing GAS procedures and their respective incidences across LMICs are shown in Table 3 A.…”

“…The remainder (n = 395/1103, 35.8%) largely underwent the modified rectosigmoid colon approach for vaginoplasty [ 20 , 33 ]. A total of 4.7% (n = 52/1103) of patients reported undergoing peritoneal pull-through vaginoplasty [ 28 ], and 3.2% (n = 35/1103) reported secondary vaginoplasty using grafts derived from abdominal tissue [ 45 ]. One study comprising n = 41 patients did not disclose the approach utilized for vaginoplasty [ 43 ].…”