Abstract：
BACKGROUND: One of the biggest challenges with gender-affirming vaginoplasty was the creation of a long-lasting, durable, patent, and self-lubricating neovaginal canal that allowed for spontaneous, pain-free sexual intercourse. The jejunum was a durable, physiologic, and intestinal option to create the neovaginal canal that minimizes the adverse effects of skin graft, peritoneal, and colonic vaginoplasties. Free jejunal vaginoplasties had been performed in cis females for congenital genitourinary anomalies like Mullerian agenesis or after gynecologic-oncologic surgery but had yet to be reported for gender-affirming vaginoplasties. The purpose of this report was to present a technique for a physiologic, intestinal, gender-affirming vaginoplasty without the disadvantages of colonic vaginoplasties.
METHODS: This report presented six patients, all natal males who identified as female, undergoing robotic-assisted free jejunal flap gender-affirming vaginoplasty. Mean age was 35.8 years (range: 21-66). Mean body mass index was 33.2 kg/m2 (range: 28.0-41.0). The proximal aspect of the neovaginal canal was created intra-abdominally by elevating peritoneal flaps from the posterior bladder wall to be reflected downward into the external neovaginal canal. The jejunal flap was harvested. The greater saphenous vein was harvested to create an arteriovenous loop between the flap vessels and the recipient femoral artery in an end-to-side fashion and a branch of the femoral vein. The jejunal flap was passed intra-abdominally through the groin incision and then trans-peritoneally into the neovaginal canal. The jejunal segment was inset to the proximal peritoneal flaps and the distal inverted penoscrotal skin of the neovaginal introitus.
RESULTS: Mean length of the harvest jejunal segment was 19.2 cm (range: 15-20). Mean time to ambulation, foley removal, and first vaginal dilation were 3.3 (range: 3-4), 4.0 (range: 3-5), and 4.5 days (range: 4-6), respectively. By a mean follow-up duration of 8.0 months (range: 1-14), mean vaginal depth and diameter were 7.0 and 1.3 cm (range: 1.0-1.5), respectively. Two (33.3%) patients experienced postoperative complications, including groin hematoma (n = 1, 16.7%) and reoperation for correction of dehiscence of the jejunal flap to the vaginal introitus (n = 1, 16.7%).
CONCLUSIONS: Gender-affirming surgeons should consider a free vascularized segment of jejunum as an option to line the neovaginal canal in the correct patients.
METHODS: This report presented six patients, all natal males who identified as female, undergoing robotic-assisted free jejunal flap gender-affirming vaginoplasty. Mean age was 35.8 years (range: 21-66). Mean body mass index was 33.2 kg/m2 (range: 28.0-41.0). The proximal aspect of the neovaginal canal was created intra-abdominally by elevating peritoneal flaps from the posterior bladder wall to be reflected downward into the external neovaginal canal. The jejunal flap was harvested. The greater saphenous vein was harvested to create an arteriovenous loop between the flap vessels and the recipient femoral artery in an end-to-side fashion and a branch of the femoral vein. The jejunal flap was passed intra-abdominally through the groin incision and then trans-peritoneally into the neovaginal canal. The jejunal segment was inset to the proximal peritoneal flaps and the distal inverted penoscrotal skin of the neovaginal introitus.
RESULTS: Mean length of the harvest jejunal segment was 19.2 cm (range: 15-20). Mean time to ambulation, foley removal, and first vaginal dilation were 3.3 (range: 3-4), 4.0 (range: 3-5), and 4.5 days (range: 4-6), respectively. By a mean follow-up duration of 8.0 months (range: 1-14), mean vaginal depth and diameter were 7.0 and 1.3 cm (range: 1.0-1.5), respectively. Two (33.3%) patients experienced postoperative complications, including groin hematoma (n = 1, 16.7%) and reoperation for correction of dehiscence of the jejunal flap to the vaginal introitus (n = 1, 16.7%).
CONCLUSIONS: Gender-affirming surgeons should consider a free vascularized segment of jejunum as an option to line the neovaginal canal in the correct patients.
摘要：
背景：确认性别的阴道成形术的最大挑战之一是创造一种持久的，耐用,专利,和自润滑新阴道管，允许自发，无痛的性交.空肠是一个持久的，生理,和肠道选择，以创建新阴道管，最大限度地减少皮肤移植的不利影响，腹膜,和结肠阴道成形术。对于先天性泌尿生殖系统异常，例如穆勒氏发育不全或妇科肿瘤外科手术后，顺式女性进行了免费的空肠阴道成形术，但尚未报道性别确认阴道成形术。本报告的目的是提出一种生理技术，肠,确认性别的阴道成形术没有结肠阴道成形术的缺点。
方法：本报告介绍了6名患者，所有确定为女性的出生男性，接受机器人辅助的游离空肠皮瓣性别确认阴道成形术。平均年龄为35.8岁（范围：21-66）。平均体重指数为33.2kg/m2（范围：28.0-41.0）。新阴道管的近端是通过将腹膜皮瓣从膀胱后壁升高到腹内形成的，以向下反射到外部新阴道管中。收获空肠皮瓣。收获大隐静脉，以在皮瓣血管和受体股动脉之间以端到端的方式和股静脉的分支形成动静脉环。空肠皮瓣腹内通过腹股沟切口，然后经腹膜进入新阴道管。空肠段插入新阴道入口的近端腹膜皮瓣和远端倒置的阴囊皮肤。
结果：收获空肠段的平均长度为19.2cm（范围：15-20）。平均步行时间，去除foley，第一次阴道扩张为3.3（范围：3-4），4.0（范围：3-5），和4.5天（范围：4-6），分别。平均随访时间为8.0个月（范围：1-14），平均阴道深度和直径分别为7.0和1.3cm（范围：1.0-1.5），分别。2例（33.3%）患者出现术后并发症，包括腹股沟血肿（n=1，16.7％）和再次手术以纠正空肠皮瓣裂开至阴道口（n=1，16.7％）。
结论：确认性别的外科医生应考虑空肠的游离血管化段作为正确患者的新阴道管的选择。
方法：本报告介绍了6名患者，所有确定为女性的出生男性，接受机器人辅助的游离空肠皮瓣性别确认阴道成形术。平均年龄为35.8岁（范围：21-66）。平均体重指数为33.2kg/m2（范围：28.0-41.0）。新阴道管的近端是通过将腹膜皮瓣从膀胱后壁升高到腹内形成的，以向下反射到外部新阴道管中。收获空肠皮瓣。收获大隐静脉，以在皮瓣血管和受体股动脉之间以端到端的方式和股静脉的分支形成动静脉环。空肠皮瓣腹内通过腹股沟切口，然后经腹膜进入新阴道管。空肠段插入新阴道入口的近端腹膜皮瓣和远端倒置的阴囊皮肤。
结果：收获空肠段的平均长度为19.2cm（范围：15-20）。平均步行时间，去除foley，第一次阴道扩张为3.3（范围：3-4），4.0（范围：3-5），和4.5天（范围：4-6），分别。平均随访时间为8.0个月（范围：1-14），平均阴道深度和直径分别为7.0和1.3cm（范围：1.0-1.5），分别。2例（33.3%）患者出现术后并发症，包括腹股沟血肿（n=1，16.7％）和再次手术以纠正空肠皮瓣裂开至阴道口（n=1，16.7％）。
结论：确认性别的外科医生应考虑空肠的游离血管化段作为正确患者的新阴道管的选择。
