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Construction of artificial vagina; with graft
CPT4 code
Name of the Procedure:
Construction of artificial vagina; with graft
Summary
This procedure involves creating or reconstructing a vagina using a graft, typically for individuals who do not have a vagina due to congenital absence, trauma, or certain surgeries. A graft, often taken from the patient’s own tissue or from a donor, is used to form the vaginal canal.
Purpose
The procedure addresses medical conditions such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, gender-affirming surgery for transgender women, or reconstruction after trauma or cancer-related surgery. The goal is to create a functional and anatomically appropriate vagina.
Indications
- Congenital conditions like MRKH syndrome.
- Gender dysphoria in transgender women seeking gender-affirming surgery.
- Reconstruction after trauma or oncological surgery.
- Patients experiencing psychological distress or physical discomfort due to the absence or damage of the vagina.
Preparation
- Patients may need to fast for several hours before the surgery.
- Medication adjustments, notably stopping certain blood thinners.
- Pre-operative consultations, including psychological assessments and medical evaluations.
- Imaging studies or other diagnostic tests to assess pelvic anatomy.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision and Preparation: A surgical site is prepared, and the required incisions are made.
- Harvesting Graft: Tissue grafts are harvested from areas such as the thigh, buttock, or bowel.
- Creation of Vaginal Canal: A space for the new vaginal canal is created between the bladder and rectum.
- Insertion of Graft: The harvested graft is shaped and sutured into place to form the new vaginal canal.
- Closure: Incisions are closed, and dressings are applied.
Duration
The procedure typically takes between 2 to 4 hours.
Setting
The procedure is performed in a hospital or an outpatient surgical center.
Personnel
- Skilled surgeons specialized in reconstructive or gender-affirming surgery.
- Anesthesiologists.
- Surgical nurses and technicians.
- Post-operative care team.
Risks and Complications
- Common: Infection, bleeding, and pain.
- Rare: Graft rejection, fistula formation, narrowing or stenosis of the neovagina, and damage to surrounding organs.
- Long-term: Scar tissue formation, which might require additional procedures.
Benefits
- Creation of a functional and anatomically appropriate vaginal canal.
- Enhanced psychological well-being and body image.
- Potential for sexual function.
Recovery
- Hospital stay for several days post-surgery.
- Instructions on wound care, activity restrictions, and hygiene.
- Possible use of vaginal dilators to maintain the canal.
- Regular follow-up appointments for monitoring.
Alternatives
- Non-surgical options like vaginal dilators alone (less effective for some conditions).
- Alternative surgical techniques (e.g., laparoscopic approaches, use of different graft materials).
- Benefits of the described procedure often include a more natural and functional outcome, but it may involve more extensive recovery compared to simpler alternatives.
Patient Experience
- Post-operative pain managed with medications.
- Discomfort and swelling are common initially but subside over time.
- Long-term follow-up care is essential for optimal outcomes and to address any complications.
- Emotional and psychological support may be beneficial and is often part of comprehensive care.