Systematic Review of Complication Rates of Gender-Affirming Procedures in the Context of Analogous Procedures in Cisgender Patients: Gender-Affirming Vaginoplasty

Purpose: Outcomes of gender-affirming vaginoplasty (GAV) can be contextualized with analogous procedures performed for vaginal agenesis (VA). This review sought to describe techniques and outcomes of GAV in the context of vaginoplasty for VA. Methods: A systematic review was performed of PubMed, Scopus, and Cochrane CENTRAL databases between January 2000 and August 2022. Separate searches were conducted for six cohorts: transgender penile inversion vaginoplasty (TG-PIV), VA McIndoe (VA-McIndoe), transgender intestinal (TG-Intestinal), VA intestinal (VA-Intestinal), transgender peritoneal (TG-Peritoneal), and VA peritoneal (VA-Peritoneal). Results: Seventy-nine studies were included in the systematic review. American Society of Plastic Surgeons level of evidence was IV (n = 75) or III (n = 4). Operative time was 2-3 h in the VA cohorts and often >4 h in the GAV cohorts. Vaginal depth varied by technique. There was one mortality in the GAV group (4508 patients). Regret was <1% in all cohorts that mentioned it. The TG-PIV (N = 3776) and VA-McIndoe (n = 180) cohorts demonstrated low rates of perioperative and long-term complications (most <5%). The TG-Intestinal (n = 580) and VA-Intestinal (n = 603) cohorts featured low rates of peritonitis or anastomotic leak and small intestinal obstruction or ileus (each <2%). The TG-Peritoneal (n = 152) and VA-Peritoneal (n = 736) comparison had low complication rates, although only two studies were included in the TG-Peritoneal cohort. Conclusions: Each cohort had low complication rates. Similar techniques were used for the creation of the vaginal canal, via skin flap/grafts, intestinal flaps, or peritoneal flaps. Differences in operative time likely reflect the addition of urethroplasty, labiaplasty, penectomy, and orchiectomy in GAV cases.