Colorectal Surgery Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Colorectal Dis. 2021 Dec;23(12):3272-3275. doi: 10.1111/codi.15952. Epub 2021 Nov 2.
Gender dysphoria is the disagreement between the gender of birth and the one with which the patient identifies. For its management it is mandatory to have a multidisciplinary team. Gender confirmation surgery with penoscrotal skin flap is the procedure of choice, and a sigmoid vaginoplasty is a feasible alternative. The new technologies and the help of indocyanine green (ICG) fluorescence can help to guarantee a correct neovagina vascularization. The objective of this paper is to present the surgical technique of laparoscopic sigmoid vaginoplasty assisted by ICG.
We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement.
Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications.
Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina.
性别焦虑是指出生时的性别与患者认同的性别之间的不一致。为了进行管理，必须有一个多学科团队。带有阴股沟皮瓣的性别确认手术是首选方法，而乙状结肠阴道成形术是一种可行的替代方法。新技术和吲哚菁绿（ICG）荧光的帮助可以帮助确保新阴道的正确血管化。本文的目的是介绍 ICG 辅助腹腔镜乙状结肠阴道成形术的手术技术。
我们介绍了两名患有性别焦虑症且有阴股沟皮瓣阴道成形术狭窄史的患者。我们通过腹腔镜方法进行了乙状结肠阴道成形术。我们开始手术，游离并切除 30 厘米长的乙状结肠，使用 ICG 辅助选择性结扎血管，180°乙状结肠旋转，反蠕动位外置，完成结肠阴道吻合和穹窿固定。我们完成了虚拟回肠造口术和引流管放置。
患者恢复良好，术后第 7 天出院，无并发症。
乙状结肠阴道成形术是一种安全可行的方法。ICG 具有重要价值，有助于选择性结扎血管，允许 180°乙状结肠旋转，并保证新阴道的冲洗。
