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Facts at a glance |
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| Criteria |
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Vaginal stenosis, shortening after SRS. |
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Very short penile skin ( less than one inch ). |
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The patient is healthy and not over weighed. |
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| Surgical Procedure |
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The bowels are prepared mechanically, the patient is placed in lithotomy. A silmultaneous abdominal and perineal approach are operated by two specialized surgeons( the general / plastic surgeon and the abdominal surgeon), then the abdominal surgeon prepares the bowel through the short low Pfannenstiel incision. The sigmoid colon is isolated about 15-20-cm-long, with the vascular pedicle from the inferior mesenteric and superior hemorrhoidal system, the remaining two ends of the colon is anastomosed by the continuance, one layer closure.
The plastic surgeon starts the perineal dissection by transversely incising the end pouch of the penile skin or the end of vaginal mucosa in the case of vaginal astresia. The dissection is carried out by eletrocautery, by palpating the urethral catheter anterior up to the retrobladder properitoneal space and the peritoneum is incised and enlarged. The general surgeon deliver the colon through the peritoneal opening after closing the proximal end, generally the rectosigmoid opening could be pulled down to the perineal skin without any tension, the anastomosis is made to the vaginal skin cuff at 1- 2 inches from the perineum, using the interrupted chronic catgut. |
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| Duration of Operation |
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Three hours | |
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| Possible Risks and Side Effects |
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Usually there is no wound infection, no intra abdominal complications, such as infection, peritonitis, obstruction, ileus, leakage of the anastomosis.The patients are lubricated vaginal canal. The mucous discharge is usually excessive during the first few months and later subsided. The vaginal atresia patients menstruate through the newly constructed colonic vagina and the short low Pfannenstiel incision was well camouflaged by underwear bikini. |
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| After Care |
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Use dilator 15 minutes twice daily for six months; sexual intercourse
is allowed after three weeks, patients have to wear tampon all the time for 3 months ( due to exercise mucous discharge ) and vaginal douche daily.
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| Recovery |
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You need to stay recuperate near the surgeon around 10-14 days at least before safely flying home, also required 4-6 weeks recuperate at home before returning to work, the neovagina can function and sexual intercourse within 4 weeks. | |
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| Results |
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Advantages:
1. Self-lubricated
2. Early sexual intercourse.
3. Very long length of vagina can accommodate penis to 8 – 10 inches.
4. Very rarely contracted or stenosed if very well cares.
Disadvantages:
1. Extra cost due to one more abdominal surgeon to open the abdomen.
2. Higher risks of abdominal and bowel surgery, can be serious in the in opperienced surgeon.
3. Need more opperienced surgeon.
4. Excessive mucous discharge, swelling in the first 6 months. | |
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| Hospital Admission |
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Five to seven nights admission to hospital. | |
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| Anesthetic |
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You can choose general anesthesia (you are asleep) or epidural or spinal anesthesia. | |
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| Post Operative Care |
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After release from Hospital patient must follow patient instructions, including:
(1) Dilating is the most important thing you can do to ensure the success of your surgery. If the patient does not dialate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture.
(2) Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed.
(3) Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina. | |
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During the recovery period, after each dilation session:
The wound should be washed gently with Hibiscrub (pink colour) in the shower followed by douching while seated in the toilet:
(i) douche proportion = 5-10 ml (cc) of Betadine solution mixed with bottled water until container is full;
(ii) insert the douche to full depth, squeeze, and hold tightly the container;
(iii) while holding tightly the container, extract the douche;
(iv) keep the wound dry and apply Betadine solution with cotton balls; and
(v) apply Kemicitine ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine napkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery. |
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Preparation |
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| Pre Operative Care |
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- Need to prepare the bowel cleansing one week before surgery by daily enema, loxative.
- Liquid diet 3 days before surgery.
- Antibiotics 48 hours before surgery.
- Inform us about any allergies, any serious medical condition(s), and all medications you are taking (both prescription and non-prescription).
- Tell your doctor if you have any serious medical condition(s).
- Avoid aspirin, ibuprofen (Advil, etc) , and vitamin E for 2 weeks prior
- Refrain from smoking 2 weeks before and 4 weeks after surgery
- Plan to be in Thailand 10-14 days altogether.
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| Passport and Visa |
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| Flight Arrangement |
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Our recommended airlines are Thai International, Northwest, Lufthansa, Singapore, and EVA which has wide seats. | |
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| Expenses |
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Surgical fee USD 13,000 |
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Travel arrangements for 7 days will be at least around 100 USD per day |
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If you are HIV positive, then you are a risk to hospital personel. For this reason you need to pay an extra 60% of the original charge. | |
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| Airport Immigration and Customs |
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Please present the supporting documents confirming the scheduled operation upon request. Please do not carry any unnecessary drugs or dangerous objects in your luggage. | |
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| Appointment with Surgeon |
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The operation can be arranged once you have all the required papers ready. Just inform us of your earliest convenient date prior to arrival, either by clicking here to contact us via e-mail. | |
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| Packing List |
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Pack only loose clothing. |
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If the patient arrives alone, it is essential to travel with light airport baggage/luggage (max. 20 kgs) to avoid risking injury during the 4-6 week recovery period. | | | |
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