Neovaginal reconstruction is necessarily performed in male transgender patients. The ideal reconstructive procedure should provide a vagina that has an appropriate length and that requires minimal, if any, dilatation. It should not scar, stenose or contract and should provide a satisfactory cosmetic result. Reconstructing the vagina using intestinal segments creates an aesthetically pleasing vagina, which seems to be more compatible with sexual activity.
After penile inversion skin flap, sigmoid colon technique presents the method of choice in transsexual surgery. Advantages of this procedure include adequate vaginal length, natural lubrication, early intercourse and a low rate of shrinkage. Sigmoid colon is particularly useful because it is anatomically similar to the perineum, with sufficient length and mobility of the segment that allows it to be easily brought into the perineum
The patient is placed in an extended lithotomy position as for a synchronous combined abdominoperineal approach. Through a Pfannenstiel incision, the sigmoid colon is mobilized from its lateral retroperitoneal attachment, as far as possible. Before making the final selection of the sigmoid colon segment, the length of the sigmoid and its mesentery should be assessed to determine whether it can reach the perineum easily. Isolated segment of rectosigmoid should be from 8 to 11 cm long, in order to avoid excessive mucus production as well as postoperative vaginal prolapse. Rectosigmoid is harvested with its blood supply originating from sigmoidal arteries and/or superior hemorrhoidal vessels. Stapling devices are used for the colorectal anastomosis as the safest procedure. Creation of the perineal cavity for vaginal replacement is performed using simultaneous approach through abdomen and perineum. Very precise dissection must be done to avoid injury of rectum, bladder and urethra. Introital or perineal skin flaps are designed for anastomosis with rectosigmoid vagina. Circumferential anastomosis is avoided to prevent purse string scarring with subsequent vaginal stenosis.
The neovagina was packed for 7 days, and an indwelling Foley catheter was left in place for 4 days. At discharge from hospital, patients were instructed to irrigate the neovagina once a day for 2 months and weekly thereafter and to dilate the introitus of the neovagina on a daily basis with a vaginal dilator.
Reconstructing the vagina using sigmoid colon creates an aesthetically pleasing vagina, which seems to be more compatible with sexual activity.