(477) Ablation Vaginectomy is a Safe and Effective Technique in Transmasculine Gender Affirmation Surgery

Abstract

Abstract Introduction Genital gender affirmation surgery ameliorates gender incongruence with the aim to align an individual’s genital appearance more closely to their experienced gender identity. Vaginectomy is commonly requested because it allows closure of the vaginal vault resulting in a masculine appearance to the perineum. Vaginectomy also allows a more appealing sac-like scrotoplasty and may reduce the risk of urethral complications. Transvaginal, laparoscopic (often combined with transvaginal) and robotically assisted approaches have been described. The transvaginal approach involves the excision of vaginal mucosa but blood loss may be significant and there is a risk of injury to adjacent organs like the bladder or rectum. Alternatively, the vaginal mucosa can be obliterated by high power electrocautery without excision. This technique has not been formally described in the literature before. Objective Pilot study to describe the technique for ablation vaginectomy (AV) and to assess the safety and efficacy of AV compared to traditional transvaginal excision vaginectomy (EV). Methods Retrospective review of a comprehensive prospective database and supplemented by medical records of transgender and non-binary persons requesting vaginectomy for gender affirmation surgery. AV was performed using high power electrocautery while EV was by a transvaginal approach. Follow-up was 30 days post-surgery. Data were reported as mean (standard error) unless specified otherwise. Results A hundred and thirty-seven patients were included in the study (62 following AV, 75 following EV). The median age (interquartile range) of both cohorts were similar [AV, 38 years (29-48); EV 37.7 years (31.5-43)]. Patients who underwent AV had a higher BMI but despite this, they had a lower intra-operative blood loss (99.8 ± 12.7mL vs 646.7 ± 63.4mL) and post-operative drain loss (90.9 ± 11.6mL vs 242.8 ± 23.6mL). More patients following EV required a transfusion (n=11) of 2.34 ± 0.5 units of packed red cells. Six patients had an intraoperative complication during EV (none for AV). Two patients had a recognised urethral perforation (one combined with a bladder injury) and 3 others had a bladder injury. All were repaired at the time. Complication rates after 30 days were similar although there was a trend for higher complications following EV (24% vs 11.3%, p=0.06). These were all related to bleeding and haematoma formation with 3.4% (AV cohort) and 8% (EV cohort) Clavien-Dindo grade 3b complications. Conclusions AV may be a feasible and safe approach when requested for gender affirmation surgery. Further prospective data with longer follow-up are required. Disclosure No