⌵ Understanding Chronic Colitis

Chronic colitis is a long-term condition characterized by persistent inflammation of the colon, or large intestine. It is an umbrella term that includes conditions like ulcerative colitis and Crohn’s disease. Symptoms can range from mild to severe and may include abdominal pain, cramping, persistent diarrhea, rectal bleeding, and weight loss. For individuals with chronic colitis, the lining of the colon is often compromised, scarred, or inflamed. This is a critical factor when considering surgical procedures that involve this part of the body.

⌵ The Surgical Solution: Sigmoid Colon vs. PPV Vaginoplasty

When a person with chronic colitis is considering gender-affirming vaginoplasty, the primary concern is surgical safety. The key is to choose a technique that provides the desired aesthetic and functional results while minimizing the risks associated with the underlying inflammation.

Sigmoid Colon Vaginoplasty

Definition: Sigmoid colon vaginoplasty is a surgical technique that uses a segment of the large intestine, specifically the sigmoid colon, to create the neovagina.

How it Works: The surgeon carefully isolates a piece of the sigmoid colon, ensuring its blood supply remains intact. This segment is then brought down and used to line the newly created vaginal canal. The remaining parts of the colon are reconnected. Because the sigmoid colon is naturally self-lubricating, this technique can result in a neovagina with natural moisture.

Considerations for Patients with Chronic Colitis: This technique is often not the ideal or safest choice for individuals with chronic colitis. Using an organ that is actively inflamed or scarred can significantly increase the risk of surgical complications. The surgeon would be creating a new organ from compromised tissue, which could lead to poor healing, infection, bowel leakage, or a higher chance of future complications related to the colitis itself. For this reason, many surgeons would recommend against it, or only consider it if the colitis is in long-term, stable remission and the colon tissue is deemed healthy.

The Surgeon’s Perspective: Surgeons will be highly cautious. They would require extensive consultation with the gastroenterologist and a clear, detailed history of your colitis and its severity. The main concern is the risk of using unhealthy tissue, which could compromise the success of the neovagina and lead to serious post-operative issues.

Peritoneal Pull-Down (PPV) Vaginoplasty

Definition: Peritoneal Pull-Down (PPV) Vaginoplasty, also known as Davydov’s procedure, uses the peritoneum, the thin membrane lining the abdominal cavity, to create the neovaginal canal.

How it Works: Using a minimally invasive laparoscopic approach, the surgeon carefully mobilizes a flap of the pelvic peritoneum. This tissue is then pulled down into the newly created vaginal space and sutured to the skin, forming a self-lubricating neovagina.

Considerations for Patients with Chronic Colitis: For those with chronic colitis, PPV vaginoplasty is often considered a much safer and more suitable technique. Since it does not involve any part of the colon, it completely avoids using the inflamed or diseased tissue that is a concern with the sigmoid colon method. This significantly reduces the risk of complications tied to your colitis.

The Surgeon’s Perspective: Surgeons often prefer this approach for patients with chronic colitis because it sidesteps the potential dangers of using compromised bowel tissue. While any abdominal surgery carries risks, a PPV procedure avoids directly manipulating the diseased organ, allowing for a safer surgical outcome.

⌵The Process of the Procedure: What to Expect

Step-by-Step Preparation

Regardless of the technique, thorough preparation is crucial. It includes:

1. A comprehensive medical evaluation with your surgeon and gastroenterologist.
2. Getting your colitis into the most stable state possible before surgery.
3. A specific bowel preparation regimen.
4. Discussions about the procedure’s risks, benefits, and expected outcomes.
5. Temporarily discontinuing certain medications as instructed.

Why You Should Choose WIH Hospital

For a procedure as complex as gender-affirming vaginoplasty, especially with a pre-existing condition, choosing the right hospital is key. WIH Hospital in Bangkok is recognized for:

• Experienced Surgeons: Our surgical team specializes in complex gender-affirming procedures and has experience working with patients who have co-existing conditions.
• Multidisciplinary Approach: We coordinate care with gastroenterologists and other specialists to ensure your colitis is well-managed before, during, and after surgery.
• State-of-the-Art Facilities: We utilize advanced surgical techniques, including minimally invasive laparoscopic surgery, which is often used for PPV.

⌵Immediate Post-Operative Care and Life-Long Instructions

Immediate Post-Operative Care

Immediately after surgery, you will receive personalized care focusing on pain management, wound care, and close monitoring in the hospital. Your medical team will provide you with detailed instructions for the initial recovery period. This includes:

Pain Management: A plan to manage any discomfort using medication.

Wound Care: Specific instructions for keeping the surgical site clean to prevent infection.

Dilation: You will begin a strict regimen of neovaginal dilation to maintain the depth and width of the canal as it heals.

Bowel and Bladder Care: Instructions on managing urinary and bowel function, which may be different initially.

Diet Plan: A specific diet to help with the healing process and to support proper bowel function.

Continued Colitis Management: Close communication with your gastroenterologist to monitor your chronic colitis and ensure it remains stable.

Life-Long Instructions

The journey doesn’t end after you leave the hospital. Long-term care is crucial for the health of your neovagina and your overall well-being. Your life-long instructions will include:

Diligent Dilation: Consistent adherence to the neovaginal dilation schedule prescribed by your surgeon to prevent the canal from narrowing or shortening. This will be a permanent part of your routine.

Regular Check-ups: Attending all scheduled follow-up appointments with your surgeon and medical team to monitor healing and long-term results.

Colitis Management: Continued, proactive management of your chronic colitis with your gastroenterologist. This is essential to prevent flare-ups that could potentially impact the surgical area and your general health.

Hygiene: Maintaining a consistent hygiene routine for the neovagina to prevent infection.

Self-Monitoring: Being aware of any changes or signs of potential complications and knowing when to contact your medical team.

⌵Which Is the Most Suitable Technique?

For the vast majority of individuals with chronic colitis, the peritoneal pull-through (PPV) vaginoplasty is the most suitable technique.

Reasons Why You Should Choose That Technique:

The primary reason to choose PPV is surgical safety. By avoiding the use of inflamed or compromised colon tissue, the PPV procedure significantly reduces the risk of complications, such as poor healing, fistula formation (an abnormal connection between organs), or infection, which are significant concerns with sigmoid colon vaginoplasty in this population. It allows you to move forward with your gender affirmation journey with a higher degree of confidence and a lower risk profile.

⌵ Comparison table for Sigmoid Colon Vaginoplasty vs PPV in patients with chronic colitis

FAQ