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Primary laparoscopic vaginoplasty in transgender women with penoscrotal hypoplasia has successful outcomes

Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia has success and complication rates comparable to alternative procedures, according to study results published in Plastic and Reconstructive Surgery.

For the prospective study, researchers assessed the surgical outcomes and follow-up of laparoscopic vaginoplasty as primary reconstruction for transgender women who had previously been treated with puberty-suppressing hormones and had developed penoscrotal hypoplasia.

From November 2007 to July 2015, there were 42 transgender women who underwent the procedure. The mean age of the patients was 21.1 ± 4.7 years, and their mean BMI was 22.5 ± 3.6 kg/m². The mean penile skin length was 6.5 ± 1.8 cm.

Intraoperatively, there was one rectal perforation that was immediately oversewn. No postoperative rectoneovaginal fistula formation or other consequences occurred due to the perforation. There was one patient death following surgery due to an atypical presentation of necrotizing fasciitis leading to septic shock and multiorgan failure. The researchers believe the patient was most likely colonized with extended-spectrum beta-lactamase–producing Escherichia coli prior to hospital admission.

Other short-term complications included three patients needing laparoscopic reoperation, one patient who was hospitalized for anastomotic leakage, and two patients with postoperative intra-abdominal bleeding. All follow up treatment was successful. At 1 year follow up, 41 patients had a functional neovagina with a mean depth of 16.3 ± 1.5 cm.

Long-term complications included six patients who required surgical correction of the introitus because of introital stenosis and two patients who developed symptoms of excessive neovaginal discharge and were diagnosed with mild diversion neovaginitis after neovaginoscopy and biopsies. These patients were also successfully treated.

“If performed by an experienced team, with the right medical infrastructure and laparoscopic equipment, [the procedure] seems to have a complication rate similar to that of other types of elective laparoscopic colorectal surgery,” the authors wrote. “It is a feasible surgical technique for primary vaginal construction, especially in transgender women with penoscrotal hypoplasia, and provides good surgical outcomes.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.