Robinson Isabel S, Cripps Courtney N, Bluebond-Langner Rachel, Zhao Lee C
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY; Department of Urology, NYU Langone Health, New York, NY.
Urology. 2023 Oct;180:105-112. doi: 10.1016/j.urology.2023.07.005. Epub 2023 Jul 20.
To describe the authors' experience with surgical management of complications following intestinal vaginoplasty and review the literature on incidence of complications following gender-affirming intestinal vaginoplasty.
Retrospective chart review identified patients presenting with complications following prior intestinal vaginoplasty requiring operative management. Charts were analyzed for medical history, preoperative exam and imaging, intraoperative technique, and long-term outcomes. Systematic literature review was performed to identify primary research on complications following gender-affirming intestinal vaginoplasty.
Four patients presented to the senior authors' clinic requiring operative intervention for complications following intestinal vaginoplasty, all of whom underwent surgical revision. Complications included vaginal stenosis (2 patients, 50%), vaginal false passage (1 patient, 25%), and diversion colitis (1 patient, 25%). Postoperatively all patients were able to dilate successfully to a depth of at least 15 cm. Systematic review identified 10 studies meeting inclusion criteria. There were 215 complications reported across 654 vaginoplasties (33% overall complication rate). Average return to operating room rate was 18%. The most common complications were stenosis (11%), mucorrhea (7%), vaginal prolapse (6%), and malodor (5%). Six intestinal vaginoplasty segments developed vascular compromise leading to flap loss. There were 2 reported mortalities.
Intestinal vaginoplasty is associated with a range of complications including vaginal stenosis, mucorrhea, and vaginal prolapse. Intra-abdominal complications, including diversion colitis, anastomotic bowel leak, and intra-abdominal abscess can occur many years after surgery, be life-threatening and require prompt diagnosis and management.
描述作者在肠道阴道成形术后并发症外科处理方面的经验，并回顾有关性别确认肠道阴道成形术后并发症发生率的文献。
通过回顾性病历审查确定先前接受肠道阴道成形术且出现需要手术处理的并发症的患者。分析病历中的病史、术前检查和影像学检查、术中技术以及长期预后情况。进行系统的文献综述以确定关于性别确认肠道阴道成形术后并发症的原始研究。
4例患者到资深作者的诊所就诊，均因肠道阴道成形术后并发症需要手术干预，所有患者均接受了手术修复。并发症包括阴道狭窄（2例，50%）、阴道瘘管（1例，25%）和改道性结肠炎（1例，25%）。术后所有患者均能成功扩张至至少15厘米的深度。系统综述确定了10项符合纳入标准的研究。在654例阴道成形术中报告了215例并发症（总体并发症发生率为33%）。平均再次手术率为18%。最常见的并发症是狭窄（11%）、黏液溢（7%）、阴道脱垂（6%）和恶臭（5%）。6个肠道阴道成形术节段出现血管受损导致皮瓣丢失。报告有2例死亡。
肠道阴道成形术会引发一系列并发症，包括阴道狭窄、黏液溢和阴道脱垂。腹部内并发症，如改道性结肠炎、吻合口肠漏和腹腔内脓肿，可在手术后多年发生，危及生命，需要及时诊断和处理。
