Technical variation and evidence maturity in gender-affirming peritoneal vaginoplasty: a systematic review.
Marleen S Vallinga, Philippine J Roijer, Melle M F Jorna et al.
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In 30 seconds
This systematic review examined technical approaches, indications, and evidence maturity for peritoneal vaginoplasty in gender-affirming surgery. It included 23 full-text studies and five video articles from 14 centers. The authors grouped techniques into four categories according to flap number, configuration, and vascularization, and found substantial variation in technique, indications, and postoperative management. Safety was the main reported outcome: 22 of 23 full-text studies reported complications, while only three included survey-based patient-reported outcomes. Two studies were most consistent with IDEAL stage 2a; the others could not be staged.
Key findings
- The review included 23 full-text studies and five video articles representing 14 centers; techniques fell into four categories.
- Indications ranged from routine primary vaginoplasty to genital skin deficiency, patient preference, and secondary reconstruction.
- Complications were reported in 22 of 23 full-text studies, but only three included survey-based patient-reported outcomes.
- Only two studies were most consistent with IDEAL stage 2a; the remaining studies could not be staged.
Why it matters
The term peritoneal vaginoplasty covers technically distinct procedures used for different indications, so evidence about one approach may not apply to another. Sparse patient-reported outcomes and inconsistent reporting also limit assessment of outcomes important to patients and comparison of safety or effectiveness. Clearer technique- and indication-specific evaluation is needed to establish the role of individual approaches.
What to keep in mind
The review reports incomplete study reporting, probable participant overlap, and heterogeneity that prevented pooled outcome synthesis.