Laparoscope‐Assisted Creation of a Neovagina Using Pedicled Ileum Segment Transfer

Abstract

The favorable long-term anatomical and functional results demonstrate that our technique is ideal for patients with congenital vaginal atresia or patients who need secondary vaginal reconstruction. For the primary male-to-female transsexuals or hermaphrodites, it can be an alternative method for vaginal construction.

Intestinal Vaginoplasty Revisited: A Review of Surgical Techniques, Complications, and Sexual Function

“…and Wu et al. used straight ileum segments 15–18 cm and 15–20 cm in length, respectively [22,23]. In a young patient group, ileum segments of 10 cm were used because of the physiological aspect [22,26].…”

“…Reported depth of the neovagina ranged from 11.5 to 13.0 cm for sigmoid grafts and from 10.5 to 18.0 cm for ileal grafts [21–23,29,31,34,35,37]. Diameter was given either in centimeters or “number of surgeon's fingers.” Based on these data, the diameter was estimated to vary between 3.7 and 4.0 cm for sigmoid grafts and between 2.5 and 4.5 cm for ileum‐derived grafts.…”

“…All could be treated with self‐dilatation. Stenosis usually occurred within the first postoperative year [23,31–33,35,36], with two exceptions, in which introital stenosis developed 14 months and 9 years after vaginoplasty [40,43].…”

Preconstruction of the Pars Pendulans Urethrae for Phalloplasty with Digestive Mucosa Using a Prefabricated Anterolateral Thigh Flap in a One-arm Patient

“…4 However, inadequacy of buccal mucosa tissues directly limits their role in reconstruction of the pars pendulans urethrae. As we have already reported our successful experience of vaginal reconstruction with the use of a pedicled ileum segment and laparoscope assistance, 5 we are then wondering if the digestive mucosa could be used for reconstruction of urethra. Lebret et al 6 had successfully developed a digestive mucosal graft for urethral construction in a Sprague-Dawley rat model and indicated digestive mucosal tube for urethral construction was technically feasible.…”

“…We believed that in fabrication of a neourethra, the digestive mucosa has unique merits as follows: (1) it is abundant and easily stretchable; (2) it is a wet epithelium, making its characteristics more histologically similar to the characteristics of urethral mucosa than skin 6,8 ; (3) it is smooth, hairless, and pliable; and (4) it has a dense subdermal plexus, rendering it more prone to obtain a blood supply from the graft site and thus to healing. 5–7 Apart from the substitute materials, we believe that the operative idea of urethral prefabrication also plays a significant role in the construction of a neourethra. According to our previously reported operation method in female-to-male transsexual patients, 9 we continued to use this effective 2-stage method of urethral prefabrication for phalloplasty in this case.…”