XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Rectosigmoid Neocalphorrhapy in Male to Female Transsexuals
(A review of 60 consecutive cases)

Wilson, Neal A., M.D., Lenaghan, Richard, M.D., Lucas, Charles M.D.

Clinical Assistant Professor of Surgery, Plastic Surgery 3011 W. Grand Blvd., Suite 571-5, Detroit, MI 48202

Since 1985, 60 cases of Rectosigmoid Neocalphorrhapys have been undertaken, the first 50 by Richard Lenaghan, M.D. All except 3 were undertaken as secondary procedures to replace contracted split skin graft and penile inversion vaginas. The youngest patient was in her early twenties, the oldest patient was in her mid-50’s and the heaviest patient was 300 lbs.

Specific points of surgical technique include: 1)Very low transverse incision with division of the rectus muscles; 2) Division of the rectum 3-6 centimeters below the peritoneal reflection to ensure the segment will reach the skin introitus; 3) Rectosigmoid segment should be 20 centimeters in length and based on the inferior mesenteric artery; 4) Rectal anastomosis is undertaken in one layer with interrupted sutures; 5) The anastomosis to the introitus should be as wide as possible and heavily "fish mouthed".

No mortality or life threatening complications. No loss of the neo-vagina. No significant bladder or rectal dysfunctions. Six patients developed introital stenosis with/or without mucosa prolapse. Five patients developed conduit stenosis due to the failure to use or dilate the neo-vagina. One anastomotic leak occurred on the 7^th day and was repaired in stages without loss of the vagina. One rectal perforation which eventually healed without fistula formation. One small bowel obstruction requiring lysis of adhesions. Two patients ruptured their neo-vagina, presented with pelvic peritonitus, were treated conservatively and recovered. One area of localized rhabdomyoblastosis was biopsied and regressed. There were no instances of colonic diseases in the neo-vagina.

Most patients describe contact bleeding of the neo-vagina mucosa until the columnar epilhelium was fattened by regular douching with betadine. Fifty percent of the patients used the neo-vagina; the other 50% required the vagina for psychological reasons rather than use, or were awaiting suitable partners.

Sixty consecutive cases of rectosigmoid neocalphorrhapy are presented. To obtain consistent and satisfactory results, planning, standardization of procedures and team training are essential.

Since this abstract, seven further cases: there were two replacements of failed skin grafts, one repair of a healed recto-vaginal fistula, one one-staged procedure and two corrections of vaginal atresia, without incident except in one of the failed skin grafts in which the rectal mesentery herniated into the perineum.