Free Jejunal Graft Vaginoplasty in Gender Affirmation Surgery: A Novel Technique

Many techniques have been described for reconstruction of the vaginal canal in gender affirmation surgery. However, none of the existing methods is known to be ideal. To overcome disadvantages of previous methods, we developed a method of vaginoplasty using a free jejunal graft. In this study, we describe the new method in detail and report postoperative results of our case series.

Between May 2022 and July 2023, 10 transfeminine patients underwent two-stage gender-affirming vaginoplasty at Korea University Anam Hospital. The first stage involved orchiectomy, urethroplasty, and neovaginal canal dissection. In the second stage, an average of 14.3 cm of jejunum was harvested via single-port laparoscopy, remodeled, and placed in the neovaginal canal. Patient characteristics, along with intra- and perioperative outcomes, were recorded.

The median patient age was 27 years (range 21-52). The median BMI was 20.1 kg/m², having received 50.6 months of hormonal replacement therapy, in average. No patient had history of gender-affirming surgery. The first surgery took 654 minutes (range 330-920 minutes) and the second surgery 283 minutes (range 150-441 minutes), in average. No major complication was noted. All patients were followed up for 6-18 months. In the donor site, two patients experienced paralytic ileus, which resolved within a week. No patient complained of persistent gastrointestinal discomfort.

A two-staged free jejunal graft for neovagina construction is a safe and effective method of gender-affirming surgery for transfeminine individuals. This paper presents a novel approach of using a free jejunal graft to line the neovagina. The new technique comprises two stages of surgery to ensure hemostasis and minimize swelling of the neovaginal canal. No major complication was noted in the donor or the recipient site after follow-up of at least 6 months on 10 patients.

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