Vaginal elongation with descending colon in patients with gender identity disorder

Background: The penile-scrotal skin flap technique is the method of choice for vaginoplasty in male-to-female transsexuals. A limited amount of available flap or postoperative complications may result in a lack of vaginal cavity depth and width, interfering with sexual intercourse. Vaginal elongation can be performed with different bowel segments, which have their merits and limitations. Elongation with descending colon has never been reported. We describe our experience using this bowel segment. Methods: We searched our hospital database for patients who underwent a vaginal elongation with descending colon after failed vaginoplasty. We analysed the postoperative course after vaginoplasty; the indications to perform an elongation; and technical details of this procedure. Patients’ further recovery was also noted. Results: From April 2010 till January 2014, 11 patients underwent vaginal elongation after failed vaginoplasty. The time interval between both operations ranged from 5 months to 30 years. Every patient had insufficient vaginal length, which was often combined with stenosis of its introitus. Reconstruction was done with descending colon and lasted 185 to 395 minutes. The last three procedures were performed laparoscopically. During the early postoperative period, one patient developed a hematoma at the colovaginal anastomosis, which was conservatively treated. Hospital stay ranged from 6 to 20 days. Conclusion: Descending colon is suitable for failed vaginoplasty. No major events during surgery or technical failures in the early postoperative phase were encountered, emphasizing that both experience and team work are of paramount importance in this challenging operation which can even be executed laparoscopically