V07-03 TRANSGENDER NEOVAGINA SACROCOLPOPEXY WITH AUTOLOGOUS FASCIA LATA

Abstract

INTRODUCTION AND OBJECTIVE: With the increasing prevalence of gender-affirming surgeries, management of the long-term complications of these surgeries is an important topic. One complication is prolapse of the neovagina in male to female transgender patients. We describe the surgical management of a complete colonic neovagina prolapse with open abdominal sacrocolpopexy utilizing autologous fascia lata graft. METHODS: A 60-year-old transgendered female underwent a male-to-female transgender surgery involving a sigmoid colon neovagina followed by a subsequent lengthening revision with additional right colon graft. She presented to our institution with one year history of severe prolapse of the neovagina with complete eversion. She had no associated bowel or bladder symptoms. A 4 cm x 17 cm fascia lata graft was harvested through a single, minimally invasive 4-inch lateral upper thigh incision. A lower midline laparotomy incision was made. The neovagina was identified and measured to be 17 cm in length, with the apex in close proximity to the sacral promontory. The fascia lata graft was reconfigured into a Y-shape with a 7 cm anterior leaflet, a 7 cm posterior leaflet, and a 3 cm tail. The anterior and posterior leaflets of the graft were then attached to the anterior and posterior aspects of the neovagina with 0-polyglactin sutures, and the tail was secured in place to the anterior longitudinal ligament of the sacrum with permanent CV-2 Gore-Tex sutures. This resulted in excellent fixation of the graft onto the neovagina and complete reduction of the prolapse. Patient was then assessed postoperatively by history, POP-Q score, and symptoms related to thigh harvest including visual analog pain (VAP) score. RESULTS: Upon follow-up, the patient had no prolapse symptoms and had complete resolution of her prolapse on physical exam. The POP-Q Stage was 0. Her VAP score at the harvest site was 1/10. She had no thigh bulge, seroma, or paresthesia at the harvest site. The patient resumed use of vaginal dilators 6-weeks postoperatively. CONCLUSIONS: Our technique of neovagina sacrocolpopexy with autologous fascia lata graft is a viable option for neovaginal prolapse repair in transgender patients. Harvest site morbidity is minor.