Peritoneal Pull-Through Vaginoplasty, or Peritoneal Vaginoplasty, is a new male to female surgery procedure that’s based on a gynecological procedure called the Davydov Procedure. 

Peritoneal Pull Through Procedure – Just as in the Davydov Procedure, an abdominal approach to obtain peritoneum and develop Denonvilliers fascia between the rectum and prostate to create a space for the neo-vagina or vaginal reconstruction. Risks include all the risks involved in a penile inversion technique if being done concurrently, as well as: stricture, stenosis, graft failure, lack of lubrication, and risks of abdominal procedure of damage to bowel, bladder, prostate, muscles, nerves, and vessels. Another risk is the lack of literature and long-term data on this procedure. 

Peritoneal Vaginoplasty Advantages: 

• Self-lubricating lining with some elasticity 
• More vaginal depth 
• Requires less dilation, less douching 
• Requires less pre-op hair removal 

• Less risk of prolapse 
• May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology 

Preparation prior to surgery: 

 Assessment of the medical history (any allergies, serious medical condition and all
medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
 Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect the healing process.
 You will likely to be asked to stop drinking alcohol a week before the surgery and throughout your recovery period.
 Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements for at least 4-6 weeks (about 1 and a half months) to prevent complicated medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding. 

Types of anesthesia use:
General Anesthetic agent 

Hospital admission: 

Admission stays in the hospital 5-7 days 

Operation time:
Surgery takes 6-8 hours 

 

During the procedure: 

During surgery, a laparoscope and several instruments are inserted through small 5-8 mm (about 0.31 in) incisions on the abdomen. These instruments allow dissection of the potential space between the lower urinary tract (urethra, prostatic urethra, and bladder) and rectum. This space will become the future vagina. Peritoneum flaps can be pulled through to the area between the urethra and the rectum to line a portion of the vaginal canal. The top of the vagina is separated from the abdominal contents by closing the peritoneal lining approximately 15 cm (about 5.91 in) from the vaginal opening. The remainder of the vaginoplasty procedures (labiaplasty, clitoroplasty, penectomy, orchiectomy, partial urethrectomy, and other associated procedures) are similar to that of the penile inversion technique. 

Recovery Period:  

The patient stayed in bed for a couple of days. No acute complications were reported. The condom with betadine-soaked petrolatum gauze was removed on day 3 post-surgery. A vitality checks of the peritoneal flap revealed good color and turgor. The drains and urinary catheter were removed, and voiding was examined. Standard wound care was applied. Vaginal dilation was performed immediately by using a small-sized acrylic dilator, twice daily, until the next follow-up visit. The patient was discharged on postoperative day 5 

Risks and Complications:  

• All the risks of penile inversion vaginoplasty. 

• Additional risks of an abdominal laparoscopic procedure, including intra-abdominal organ injury, ileus, herniation, and others. 
• Flap failure and stenosis. 
• Unknown long-term outcomes.