(233) Primary Sigmoid Vaginoplasty in Gender Affirmation Surgery: Technique and Outcomes

Abstract Introduction Gender-affirming surgery has become a recognized component of the transition process for transgender individuals. These surgeries enhance life quality and enable patients to engage in emotionally and sexually satisfying relationships. Various methods have been employed to construct a neovaginal canal.While no single technique is deemed optimal, inversion vaginoplasty using penile-scrotal flaps is the most favored and widely practiced approach among surgeons.there are instances where adequate penile-scrotal skin is unavailable due to anatomical constraints or patient expectations concerning vaginal depth.Moreover, it is increasingly common for younger individuals to undergo hormonal suppression in preparation for gender transition.Intestinal vaginoplasty is a well-established method for addressing congenital or acquired vaginal absence.In transgender patients, this technique is more frequently employed as a revision procedure following primary failure or complications like vaginal stenosis.Utilizing the intestinal segment ensures reliable achievement of sufficient depth. Intestinal grafts are less prone to shrinkage, reducing the necessity for lifelong dilation.the mucosa resembles vaginal mucosa in appearance and texture, with the added advantage of self-lubrication. Although elective bowel resection is often viewed as an unnecessary risk, recent data suggest fewer gastrointestinal complications in intestinal vaginoplasty than previously believed.In this study, we present a retrospective series of 10 consecutive patients who underwent primary sigmoid vaginoplasty between 2023 and 2024 at our center. Objective Sigmoid vaginoplasty is a dependable surgical option with minimal complications that provides satisfactory vaginal depth for transgender women. Methods A prospective database was established to record information on patients who underwent primary sigmoid colon vaginoplasty at our center between 2023 and 2024. The collected data included baseline demographics, medical and surgical history, smoking status, complications, and postoperative vaginal depth. Vaginal depth was assessed using a dilator and reported in inches. Results From 2023 to 2024, 10 patients underwent primary sigmoid colon vaginoplasty. The average age of the patients was 30 years (± 5.4 years), and their average BMI was 26.8 (± 4.9). All patients were Indian and were undergoing estrogen therapy for gender transition. Overall, 80% (8 of 10) of patients had no intraoperative or postoperative complications. Two complications occurred: one patient experienced an anastomotic leak, and another had an intraoperative anal canal injury 3 cm from the anal verge, necessitating ileostomy. The reoperation rate was 10 %, with one patient requiring surgery due to an anastomotic leak. Additionally, one patient (10%) developed vaginal stenosis at the neointroitus, which was successfully treated with dilation. Detailed information on the complications and their management is outlined below. Conclusions Sigmoid vaginoplasty is a dependable method that closely resembles the natural vaginal lining and offers a satisfactory tactile experience, ensuring both sexual function and patient contentment. Achieving optimal results for the patient necessitates a collaborative effort among a proficient surgeon, a transgender healthcare team, a urologist, and a plastic surgeon. Disclosure No