QS304 - Primary versus Revision Intestinal Vaginoplasty for Gender-Affirmation

Tuesday, June 4, 2024

8:09 AM – 8:12 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Anyelin Almanzar Hirujo, MD

Fellow
Medstar Washington Hospital Center
Medstar Washington Hospital Center
Washington, DC, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

SS

Sami Shoucair, MD

General Surgeon
Meritus Medical Center
Baltimore, Maryland, United States

Disclosure information not submitted.
SA

Said Alnajjar, MD

General Surgery Resident
Medstar Franklin Square Medical Center
Baltimore, Maryland, United States

Disclosure information not submitted.
YW

Yixi Wang, MD

General Surgery Resident
Medstar Franklin Square Medical Center
Baltimore, Maryland, United States

Disclosure information not submitted.
SD

Sophia Dahmani, MS

Medical Student
Georgetown University
Washington, District of Columbia, United States

Disclosure information not submitted.
CD

Connor Doyle, MS

Medical Student
Georgetown University
Washington, District of Columbia, United States

Disclosure information not submitted.
KH

Krystal M. Henderson, MS

Medical Student
Georgetown University School of Medicine
Rio Rancho, New Mexico, United States

Disclosure information not submitted.

Senior Author(s)

DL

David Lisle, MD, FACS, FACRS

Colorectal Surgeon
Medstar Franklin Square Medical Center
Baltimore, Maryland, United States

Disclosure information not submitted.

Purpose/Background: Intestinal vaginoplasty has been well described in the literature as an effective treatment modality for transgender women seeking gender-affirming surgery. Historically, vaginoplasty with intestinal conduit had been reserved as an option for revision for vaginal stenosis developed after non intestinal vaginoplasty. Nowadays, intestinal conduits are increasingly being considered as a primary procedure for patients with penile hypoplasia. Data is lacking regarding the clinicodemographic and outcome differences between the two groups.

Methods/Interventions: This was a retrospective, single-center study in which patients who had undergone gender-affirming vaginoplasties using intestinal conduits at our institution in Baltimore, Maryland between January 2019-June 2023, were identified. The primary endpoint was to compare the outcomes of primary vs. revision intestinal vaginoplasty, the latter being defined as intestinal conduit vaginoplasty after a prior vaginoplasty using non-intestinal conduit.

Results/Outcomes: Thirty-six patients who met the inclusion criteria were identified. Overall, 44% of patients underwent a primary intestinal vaginoplasty (n=16) and 55% underwent a revision intestinal vaginoplasty (n=20). Of these, 86.2% (n=31) used a colonic conduit, whereas 13.8% (n=5) used a jejunal free flap conduit. Mean age of the overall cohort was 35.4. Approach for all cases was robotic assisted. When comparing primary and revision intestinal conduit vaginoplasty, patients of White race were more likely to undergo a primary intestinal conduit than a revision intestinal conduit (75% vs 25%, p= < 0.004). In terms of marital status, patients who were single were more likely to undergo a revision intestinal conduit than a primary conduit (70% vs 56.3%, p=0.012), whereas divorced patients were more likely to undergo primary conduit over revision (18.8% vs. 1%, p=0.012). Furthermore, patients who underwent revision conduit had spent more years living as female and receiving hormone replacement therapy, compared to those who underwent a primary conduit (9.5 ± 5.6 vs. 4.1 ± 2.7, p=0.003) (8.6 ± 4.3 vs. 5.1 ± 3.2, p=0.014). No difference in outcomes was noted between the two groups, including for reoperation, anastomotic leak, bleeding, ileus, vaginal prolapse and vaginal stenosis at 90 days.

Conclusion/Discussion: While there are some racial disparities as to which patients undergo a primary vs revision intestinal vaginoplasty, there are no differences in postoperative outcomes between each group. Therefore, it is safe to conclude that these findings support patient preference when deciding which procedure to perform first.