For patients who have already undergone sex reassignment surgery but are dissatisfied with the depth of their neovagina or for patients whose vaginal canal has collapsed and/or decreased, revised sigmoid colon vaginoplasty, also known as secondary sigmoid colon vaginoplasty, is recommended. 

The overall length of the vaginal canal is typically less tha inflammatory n 3 inches in cases of insufficient depth. Because it cannot be used for sex with a penis of average size, this length is regarded as non-functional. 

Reconstructive surgery utilizing a skin graft is not an option for this issue since the graft might not accept the scar area once the wound has passed the inflammatory stage. Since it can live even after the lesion has passed the stage, further colon vaginoplasty is required to increase the vaginal depth and recreate functional neovagina. 

Numerous variables, such as: Insufficient skin grafted during a prior vaginoplasty, can lead to vaginal canal collapse and abnormally shallow neovagina. 

Vaginal walls collapse due to skin graft failure or inadequate wound healing. 

The patients failed to maintain an acceptable vaginal depth because they did not consistently adhere to the prescribed dilation plan. 

 Surgical Method 

The surgeon will first remove the scar or contracted skin before making changes to the vaginal width to restore the vaginal canal. The colon graft will next be joined inside the vaginal canal to produce a functional, long neovagina. 

Prior to the Operation 

Four weeks before surgery, all hormone and anti-androgen injections must be totally ceased. 

To reduce the risk of deep vein thrombosis (DVT), oral pills and other treatments like skin gels and patches should be stopped two weeks prior to surgery. 

Prior to surgery, you should give up smoking for four to six weeks, and you shouldn’t start again for at least one month after the procedure. 

Ibuprofen, Advil, and vitamin E supplements shouldn’t be taken for two weeks before to surgery. 

Take a shower the morning of the procedure because you won’t be allowed to for five days thereafter. 

After the procedure, make plans to stay in Thailand for at least 7–10 days (about 1 and a half weeks). 

Recovery Period 

The average hospital stay for post-operative recuperation is 6 days. 

We recommend that you stay in a hotel near the hospital for at least two weeks after discharge before flying back to your own country. 

It is typical to suffer some discomfort following surgery, but this may be managed with medication and antibiotics. After 2-3 days, the pain will gradually lessen. 

You’ll need a urinary catheter that can stay in place for at least 5 days. 

The catheter may cause some pain, swelling, and irritation, but this should go away after 2-3 days. 

To induce bowel movement, you should begin walking around as soon as feasible. 

At the conclusion of the surgery, a vaginal packing will be implanted and will remain in place for 5 days. The vaginal packing, tube drain, and catheter will be removed completely on the sixth day. 

If you have trouble urinating after being discharged from the hospital, you should go back to the hospital or contact your surgeon as soon as possible. 

Following surgery, you will be given a nutrition plan to follow as well as instructions to prevent deep vein thrombosis (DVT). 

After being discharged from the hospital, you will be given home care instructions for cleaning and caring for the wound, which must be carefully followed. 

Vaginal dilatation will be demonstrated to you. You must strictly adhere to the dilation instructions provided to you. 

 Continue to take all medications that your surgeon has ordered. 

For at least four weeks, vaginal intercourse should be avoided. 

In general, hormone therapy can be resumed after 3-4 weeks or when the surgical site has healed fully.