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Outcomes of Peritoneal Flap Vaginoplasty for Transgender Women: A Systematic Review of the Literature
Phuong-Uyen Catherine Tran, BS1, Hadis Askari, BS2, Rachel Bluebond-Langner, MD3, Lee C. Zhao, MD, MS3.
1UMass Chan School of Medicine, Worcester, MA, USA, 2Texas Tech University Health Sciences Center School of Medicine, Austin, TX, USA, 3New York University, New York, NY, USA.
BACKGROUND: Peritoneal flap vaginoplasty (PFV) is a technique for neovaginal reconstruction in which vascularized flaps of peritoneum are mobilized from the pelvic cavity to line the neovaginal canal. This approach is now considered alongside traditional penile inversion vaginoplasty (PIV) as a primary option for gender-affirming surgery (GAS). We sought to evaluate PFV techniques and outcomes associated with PFV among transgender women.
METHODS: A systematic search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar. Outcomes of interest included final neovaginal depth measurements, perioperative complications, and postoperative revisions. To prevent duplication, studies derived from the same dataset were identified and the most complete publication was included.
RESULTS: Eight studies involving 666 total patients were included. The mean age and BMI at time of surgery ranged from 18.3 (SD=0.6) to 41.0 (SD=15.0) years and 23.1 (SD=4.7) to 30.9 (SD=5.4) kg/mē. The mean operative time and follow-up duration ranged from 262.0 (SD=34.7) to 542.2 (SD=72.7) minutes and 3.8 (SD=2.6) to 31.3 (SD=15.8) months. Final postoperative vaginal depth ranged from 11.0 (SD=3.2) to 14.5 (SD=not reported (NR)) cm. The majority of PFV cases were for primary GAS; of 47 patients who underwent secondary PFV, 45 had failed prior PIV by neovaginal stenosis. Intra-abdominal complications such as bowel obstruction (0.2%) and fistula formation (1%) were rare. Neovaginal stenosis and wound dehiscence were observed postoperatively in 8.3% and 2-5% of total cases, respectively. Postoperative revision vaginoplasty was performed for 13 cases (2%).
CONCLUSIONS: PFV is a safe and effective surgical technique to provide adequate postoperative vaginal depth in both primary and revision GAS, with low risk of intra-abdominal complications. Further studies are needed to better define long-term outcomes.
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