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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

  1. Anesthesia: General anesthesia is administered.
  2. Incision and Preparation: A surgical site is prepared, and the required incisions are made.
  3. Harvesting Graft: Tissue grafts are harvested from areas such as the thigh, buttock, or bowel.
  4. Creation of Vaginal Canal: A space for the new vaginal canal is created between the bladder and rectum.
  5. Insertion of Graft: The harvested graft is shaped and sutured into place to form the new vaginal canal.
  6. 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.

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