Bouman Mark-Bram, van der Sluis Wouter B, Buncamper Marlon E, Özer Müjde, Mullender Margriet G, Meijerink Wilhelmus J H J
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.
Plast Reconstr Surg. 2016 Oct;138(4):614e-623e. doi: 10.1097/PRS.0000000000002549.
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.
Baseline demographics, surgical characteristics, and intraoperative and postoperative complications of all performed total laparoscopic sigmoid vaginoplasty procedures were prospectively recorded.
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.
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.
CLINICAL QUESTIO/LEVEL OF EVIDENCE: Therapeutic, IV.
在先前接受过青春期抑制激素治疗的年轻跨性别女性中，阴茎阴囊发育不全可能使阴茎阴囊翻转阴道成形术不可行。本研究的目的是前瞻性评估全腹腔镜乙状结肠阴道成形术作为阴茎阴囊发育不全的跨性别女性队列的初次重建手术的效果及随访情况。
前瞻性记录所有已实施的全腹腔镜乙状结肠阴道成形术的基线人口统计学资料、手术特征以及术中及术后并发症。
2007年11月至2015年7月，42例跨性别女性接受了全腹腔镜乙状结肠阴道成形术作为初次阴道重建手术。手术时的平均年龄为21.1±4.7岁。平均随访时间为3.2±2.1年。平均手术时长为210±44分钟。无转为开腹手术的情况。手术中发现1例直肠穿孔并立即进行了缝合，未产生长期后果。平均住院时长为5.7±1.1天。1例患者因产超广谱β-内酰胺酶阳性坏死性筋膜炎导致感染性休克及多器官功能衰竭死亡。需要腹腔镜再次手术的直接术后并发症发生在3例患者中（7.1%）。7例患者（17.1%）出现长期并发症需要二次矫正。1年后，所有患者均拥有功能正常的新阴道，平均深度为16.3±1.5厘米。
全腹腔镜乙状结肠阴道成形术的并发症发生率似乎与其他类型的择期腹腔镜结直肠手术相似。对于阴茎阴囊发育不全的跨性别女性，初次全腹腔镜乙状结肠阴道成形术是一种可行的性别确认手术技术，功能效果良好。
临床问题/证据级别：治疗性，IV级
