Ann Chir Plast Esthet. 2019 Feb;64(1):24-32. doi: 10.1016/j.anplas.2018.08.002. Epub 2018 Sep 27.

Postoperative complications of male to female sex reassignment surgery: A 10-year French retrospective study.

Cristofari S¹, Bertrand B², Leuzzi S³, Rem K⁴, Rausky J⁴, Revol M⁴, Atlan M⁵, Stivala A⁶.

Author information

1: Department of plastic, reconstructive and aesthetic surgery, Saint-Louis hospital, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; Paris Diderot university, Sorbonne Paris, Paris, France; Plastic and aesthetic surgery department, hôpital Tenon, Paris, France.
2: Plastic and reconstructive surgery, Conception hospital, 147, boulevard Baille, 13005 Marseille, France.
3: Department of plastic, reconstructive and aesthetic surgery, Saint-Louis hospital, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
4: Department of plastic, reconstructive and aesthetic surgery, Saint-Louis hospital, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; Paris Diderot university, Sorbonne Paris, Paris, France.
5: Plastic and aesthetic surgery department, hôpital Tenon, Paris, France.
6: Department of plastic, reconstructive and aesthetic surgery, Saint-Louis hospital, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; Plastic and reconstructive surgery, François-Mitterand hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France. Electronic address: drstivala@gmail.com.

Abstract

In primary male to female (MTF) sex reassignment surgery (SRS), the most frequent postoperative functional complications using the penoscrotal skin technique remain neovaginal stenosis, urinary meatal stenosis and secondary revision surgery. We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion. All patients operated on for MTF SRS, using the inverted technique, from June 2006 to July 2016, were retrospectively reviewed. The minimum follow-up was one year (five-years maximum follow-up). Soft postoperative dilationprotocol was prescribed until complete healing of the vagina. We did not prescribe long-term hard dilation systematically. Possible short-depth neovaginas were primarily treated with further temporary dilation using a hard bougie. Among the 189 included patients, we reported a 2.6% of rectovaginal wall perforations. In 37% of patients we had repeated compressive dressings and 15% of them required blood transfusions. Eighteen percent of patients presented with hematoma and 27% with early infectious complications. Delayed short-depth neovagina occurred in 21% of patients, requiring additional hard dilatation, with a 95.5% success rate. Total secondary vaginoplasty rate was 6.3% (4.7% skin graft and 3.7% bowel plasty). Secondary functional meatoplasty occurred in 1% of cases. Other secondary cosmetic surgery rates ranged between 3 to 20%. A low rate of secondary functional meatoplasty was showed after MTF SRS by penile skin inversion. Hard dilation was prescribed in case of healed short-depth vagina, with good efficiency in most of cases. Secondary vaginoplasty was required in cases of neovagina stenosis or persisting short-depth neovagina after failure of hard dilation protocol.