Colon graft vaginoplasty

Rectosigmoid (colon graft or colon transplant) is a procedure, in which a section of the rectosigmoid colon is used to provide a cosmetic, self-lubricating neovagina.  However, it should be considered only when penile skin inversion technique has not led to satisfying results. This procedure is more intrusive than penile inversion as the abdominal cavity is entered. The use of rectosigmoid colon segment provides excellent depth of the new vagina (more than eight inches) with low rate of failure, and without the need for prolonged stinting or dilatation.

Surgical technique

 

  • Patients are placed in lithotomy position. A simultaneous abdominal and perineal approach is performed by two teams.
  • A Pfannenstiel incision (low transverse abdominal incision) is used for entering the abdominal cavity.
  • A 18-20 cm. of the colon segment is selected for transplantation on its rectal vascular pedicle as a modifying method described by R.C Franz (M.D.), whereby transection of the mesenteric vessels provides immediate mobility for the colon segment to reach the perineum.
  • The mobility provided at this step is excellent. The distal colon opening can be easily slid down through the previous constructed tunnel for suturing to the vaginal opening by the plastic surgeon.
  • The proximal end of the colon segment is closed with running of non-absorbable sutures. The abdomen is closed without drainage.
  • The distal opening of the colon segment is sutured to the vaginal opening skin. The Z-plasty and perineal skin V flap are used to decrease the effect of circular scar contracture at the mucous-skin junction.

     

    Preoperative assessment and preparation

  • At the first inspection, your external genitalia, existing vaginal depth and condition of scarring inside will be evaluated carefully.
  • You may be ask for specific bowel investigation such as barium enema, if necessary.
  • You need to admit into the hospital 2 days for bowel preparation prior to the surgery . Only residue-free liquids are permitted and cleansing soap enemas are prescribed.
  • Hormonal treatment has been discontinued for at least 2 weeks in order to prevent abnormal blood clot condition.

    Postoperative recovery after colon procedure

  • Nothing must be taken orally for at least 2 days.
  • When your bowel starts to move again, you will be given a residual-free diet first, and then liquid diet and soft diet respectively.
  • The vaginal packing and urinary catheter are removed at the fourth days.
  • You will be asked to start gently dilate and douche the vagina. However, during your recovery period in hospital and also in your selected hotel, all of your after care will be supervised by our staff.
  • Early ambulation helps speed up the recovery function of your bowel and also reduces the risk of thromboemboli (blood clot in vessels esp. in the lungs). So, you are allowed to get out of bed at the fifth day.
  • The colon procedure required 7-10 days in the hospital.
  • All stitches are self-dissolving.

    Possible complications

  • The risk of wound infection increases, especially when the rectosigmoid is considered for primary vaginoplasty.
  • Vaginal opening narrowing is due to circular scar contracture at the mucoperineal junction.
  • Abundant mucous discharge from neovagina.