1. Source of Tissue:

• Peritoneal Pull-Through: This technique uses the peritoneum, a thin, naturally lubricated membrane that lines the abdominal cavity. It provides a good depth and a naturally moist neovagina.
• Sigmoid Colon Vaginoplasty: This technique uses a section of the sigmoid colon, which also provides a lubricated neovagina and can offer significant depth.

2. Natural Lubrication:

• Peritoneal Pull-Through: The peritoneum naturally produces a small amount of lubrication, which can be advantageous for sexual activity. However, the amount of lubrication is generally less than what is provided by the sigmoid colon.
• Sigmoid Colon Vaginoplasty: The sigmoid colon produces a considerable amount of mucus, resulting in a very lubricated neovagina, often more so than the peritoneal technique. This can be advantageous for some patients, but may require regular hygiene to manage the excess mucus.

3. Aesthetic and Sensory Outcome:

• Peritoneal Pull-Through: The peritoneal lining provides a smooth, elastic neovagina. It is also a relatively thin tissue, which may lead to a neovagina with a softer and more natural feel.
• Sigmoid Colon Vaginoplasty: The tissue from the sigmoid colon is thicker and more robust, which can result in a firmer neovagina. Some patients may notice a different texture compared to the peritoneal or penile inversion techniques.

4. Risk of Complications:

• Peritoneal Pull-Through: This technique has a relatively low risk of complications, particularly related to the neovagina itself, such as stenosis (narrowing) or fistula formation. The use of minimally invasive techniques like laparoscopy can reduce the risk of post-operative complications.
• Sigmoid Colon Vaginoplasty: While generally safe, this technique carries a higher risk of complications such as bowel leakage, infection, or issues related to the colon graft, like strictures or prolapse. The involvement of the bowel also increases the complexity of the surgery.

5. Surgical Complexity and Recovery:

• Peritoneal Pull-Through: The surgery is complex but less so than sigmoid colon vaginoplasty. Recovery tends to be shorter, and patients may experience fewer gastrointestinal issues post-operatively.
• Sigmoid Colon Vaginoplasty: This is a more complex surgery due to the involvement of the gastrointestinal tract. Recovery can be longer, and there may be additional considerations related to bowel function post-operatively.

6. Functional Longevity:

• Peritoneal Pull-Through: The peritoneal tissue is stable and less prone to long-term complications. It maintains its structure well over time, although it may require regular dilation to prevent narrowing.
• Sigmoid Colon Vaginoplasty: The sigmoid colon graft is also durable, but its maintenance involves managing excess mucus and ensuring that bowel-related complications do not develop over time.

7. Indications for Use:

• Peritoneal Pull-Through: This technique is particularly useful for patients who lack sufficient penile and scrotal tissue and prefer a less invasive option compared to using bowel tissue. It’s also preferred by patients who want to avoid the potential complications related to bowel surgery.
• Sigmoid Colon Vaginoplasty: This technique is often used for patients who require significant vaginal depth and robust tissue, or for those who prefer the additional lubrication provided by the colon. It’s also a good option for patients with prior abdominal surgeries that may have affected the peritoneum.

8. Scarring:

• Peritoneal Pull-Through: Scarring is minimal, particularly when the procedure is done laparoscopically. Most of the surgery is internal, leading to a cosmetically favorable outcome.
• Sigmoid Colon Vaginoplasty: This technique typically involves more scarring due to the need for a larger abdominal incision, particularly if the surgery is performed via an open approach rather than laparoscopically.

The peritoneal pull-through vaginoplasty offers advantages in terms of reduced surgical complexity, lower risk of gastrointestinal complications, and a shorter recovery period. It is a good option for patients seeking a naturally lubricated neovagina with minimal scarring and a lower risk of complications.

The sigmoid colon vaginoplasty, on the other hand, is advantageous for patients who need greater vaginal depth and prefer a more lubricated neovagina, though it comes with a higher complexity and potential for bowel-related complications. The choice between these techniques should be made in consultation with an experienced surgeon, taking into account the patient’s specific anatomical needs, health considerations, and personal preferences.