Systematic Review of Complication Rates of Gender-Affirming Procedures in the Context of Analogous Procedures in Cisgender Patients: Gender-Affirming Vaginoplasty
Restricted accessResearch articleFirst published online 2025
Systematic Review of Complication Rates of Gender-Affirming Procedures in the Context of Analogous Procedures in Cisgender Patients: Gender-Affirming Vaginoplasty
Outcomes of gender-affirming vaginoplasty (GAV) can be contextualized with analogous procedures performed for vaginal agenesis (VA). This review sought to describe techniques and outcomes of GAV in the context of vaginoplasty for VA.
Methods:
A systematic review was performed of PubMed, Scopus, and Cochrane CENTRAL databases between January 2000 and August 2022. Separate searches were conducted for six cohorts: transgender penile inversion vaginoplasty (TG-PIV), VA McIndoe (VA-McIndoe), transgender intestinal (TG-Intestinal), VA intestinal (VA-Intestinal), transgender peritoneal (TG-Peritoneal), and VA peritoneal (VA-Peritoneal).
Results:
Seventy-nine studies were included in the systematic review. American Society of Plastic Surgeons level of evidence was IV (n = 75) or III (n = 4). Operative time was 2–3 h in the VA cohorts and often >4 h in the GAV cohorts. Vaginal depth varied by technique. There was one mortality in the GAV group (4508 patients). Regret was <1% in all cohorts that mentioned it. The TG-PIV (N = 3776) and VA-McIndoe (n = 180) cohorts demonstrated low rates of perioperative and long-term complications (most <5%). The TG-Intestinal (n = 580) and VA-Intestinal (n = 603) cohorts featured low rates of peritonitis or anastomotic leak and small intestinal obstruction or ileus (each <2%). The TG-Peritoneal (n = 152) and VA-Peritoneal (n = 736) comparison had low complication rates, although only two studies were included in the TG-Peritoneal cohort.
Conclusions:
Each cohort had low complication rates. Similar techniques were used for the creation of the vaginal canal, via skin flap/grafts, intestinal flaps, or peritoneal flaps. Differences in operative time likely reflect the addition of urethroplasty, labiaplasty, penectomy, and orchiectomy in GAV cases.
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References
1.
OlesN, DarrachH, LandfordW, et al.Gender affirming surgery: A comprehensive, systematic review of all peer-reviewed literature and methods of assessing patient-centered outcomes (part 2: Genital reconstruction). Ann Surg, 2022; 275(1):e67–e74; doi: 10.1097/sla.0000000000004717
2.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021; 372:n71; doi: 10.1136/bmj.n71
3.
American Society of Plastic Surgeons. ASPS Evidence Rating Scales. American Society of Plastic Surgeons: Arlington Heights, IL; 2011.
4.
SlimK, NiniE, ForestierD, et al.Methodological index for non-randomized studies (minors): Development and validation of a new instrument. ANZ J Surg, 2003; 73(9):712–716; doi: 10.1046/j.1445-2197.2003.02748.x
5.
Fitzpatrick-LewisD, CiliskaD, ThomasH. The Methods for the Synthesis of Studies without Control Groups. National Collaborating Centre for Methods and Tools: Ontario, Canada; 2009.
6.
BalduzziS, RückerG, SchwarzerG. How to perform a meta-analysis with r: A practical tutorial. Evid Based Ment Health, 2019; 22(4):153–160; doi: 10.1136/ebmental-2019-300117
7.
LuoD, WanX, LiuJ, et al.Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res, 2018; 27(6):1785–1805; doi: 10.1177/0962280216669183
8.
WanX, WangW, LiuJ, et al.Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014; 14:135; doi: 10.1186/1471-2288-14-135
9.
BuncamperME, van der SluisWB, van der PasRSD, et al.Surgical outcome after penile inversion vaginoplasty: A retrospective study of 475 transgender women. Plast Reconstr Surg, 2016; 138(5):999–1007; doi: 10.1097/prs.0000000000002684
10.
OpsomerD, VynckeT, MertensD, et al.Fifteen-year experience with the Ghent technique of penile inversion vaginoplasty. Plast Reconstr Surg, 2021; 148(3):416e–424e; doi: 10.1097/prs.0000000000008300
11.
GaitherTW, AwadMA, OsterbergEC, et al.Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol, 2018; 199(3):760–765; doi: 10.1016/j.juro.2017.10.013
12.
ReedHM. Aesthetic and functional male to female genital and perineal surgery: Feminizing vaginoplasty. Semin Plast Surg, 2011; 25(2):163–174; doi: 10.1055/s-0031-1281486
13.
LevyJA, EdwardsDC, Cutruzzula-DreherP, et al.Male-to-female gender reassignment surgery: An institutional analysis of outcomes, short-term complications, and risk factors for 240 patients undergoing penile-inversion vaginoplasty. Urology, 2019; 131:228–233; doi: 10.1016/j.urology.2019.03.043
14.
LawrenceAA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav, 2006; 35(6):717–727; doi: 10.1007/s10508-006-9104-9
15.
GoddardJC, VickeryRM, QureshiA, et al.Feminizing genitoplasty in adult transsexuals: Early and long-term surgical results. BJU Int, 2007; 100(3):607–613; doi: 10.1111/j.1464-410X.2007.07017.x
CristofariS, BertrandB, LeuzziS, et al.Postoperative complications of male to female sex reassignment surgery: A 10-year french retrospective study. Ann Chir Plast Esthet, 2019; 64(1):24–32; doi: 10.1016/j.anplas.2018.08.002
18.
JarolímL, ŠedýJ, SchmidtM, et al.Gender reassignment surgery in male-to-female transsexualism: A retrospective 3-month follow-up study with anatomical remarks. J Sex Med, 2009; 6(6):1635–1644; doi: 10.1111/j.1743-6109.2009.01245.x
19.
HessJ, HenkelA, BohrJ, et al.Sexuality after male-to-female gender affirmation surgery. Biomed Res Int, 2018; 2018:9037979; doi: 10.1155/2018/9037979
20.
MassieJP, MorrisonSD, Van MaasdamJ, et al.Predictors of patient satisfaction and postoperative complications in penile inversion vaginoplasty. Plast Reconstr Surg, 2018; 141(6):911e–921e; doi: 10.1097/prs.0000000000004427
21.
MaurerV, HowaldtM, FeldmannI, et al.Penile flap inversion vaginoplasty in transgender women: Contemporary morbidity and learning-curve analysis from a high-volume reconstructive center. Front Surg, 2022; 9:836335; doi: 10.3389/fsurg.2022.836335
22.
PerovicSV, StanojevicDS, DjordjevicML. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int, 2000; 86(7):843–850; doi: 10.1046/j.1464-410x.2000.00934.x
23.
PanicA, RahmaniN, KasparC, et al.Transrectal ultrasound guided hydrodistension - a new surgical way in transgender surgery. J Sex Med, 2021; 18(6):1134–1140; doi: 10.1016/j.jsxm.2021.03.011
24.
FalconeM, TimpanoM, CerutiC, et al.A single-center analysis on the learning curve of male-to-female penoscrotal vaginoplasty by multiple surgical measures. Urology, 2017; 99:234–239; doi: 10.1016/j.urology.2016.07.012
25.
FakinRM, GiovanoliP. A single-center study comparison of two different male-to-female penile skin inversion vaginoplasty techniques and their 3.5-year outcomes. J Sex Med, 2021; 18(2):391–399; doi: 10.1016/j.jsxm.2020.09.014
26.
RaigosaM, AvvedimentoS, YoonTS, et al.Male-to-female genital reassignment surgery: A retrospective review of surgical technique and complications in 60 patients. J Sex Med, 2015; 12(8):1837–1845; doi: 10.1111/jsm.12936
27.
WagnerS, GrecoF, HodaMR, et al.Male-to-female transsexualism: Technique, results and 3-year follow-up in 50 patients. Urol Int, 2010; 84(3):330–333; doi: 10.1159/000288238
28.
Cardoso da SilvaD, SchwarzK, FontanariAM, et al.WHOQOL-100 before and after sex reassignment surgery in Brazilian male-to-female transsexual individuals. J Sex Med, 2016; 13(6):988–993; doi: 10.1016/j.jsxm.2016.03.370
29.
WhynottRM, SummersK, MickelsenR, et al.A retrospective cohort study evaluating surgical aptitude over time in a new male-to-female penoscrotal vaginoplasty program. J Sex Med, 2020; 17(9):1787–1794; doi: 10.1016/j.jsxm.2020.05.032
30.
NijhuisTHJ, ÖzerM, van der SluisWB, et al.The bilateral pedicled epilated scrotal flap: A powerful adjunctive for creation of more neovaginal depth in penile inversion vaginoplasty. J Sex Med, 2020; 17(5):1033–1040; doi: 10.1016/j.jsxm.2020.02.024
31.
PapadopulosNA, ZavlinD, LelléJD, et al.Combined vaginoplasty technique for male-to-female sex reassignment surgery: Operative approach and outcomes. J Plast Reconstr Aesthet Surg, 2017; 70(10):1483–1492; doi: 10.1016/j.bjps.2017.05.040
32.
ManriqueOJ, AdabiK, HuangTC, et al.Assessment of pelvic floor anatomy for male-to-female vaginoplasty and the role of physical therapy on functional and patient-reported outcomes. Ann Plast Surg, 2019; 82(6):661–666; doi: 10.1097/sap.0000000000001680
33.
LoreeJT, BurkeMS, RippeB, et al.Transfeminine gender confirmation surgery with penile inversion vaginoplasty: An initial experience. Plast Reconstr Surg Glob Open, 2020; 8(5):e2873; doi: 10.1097/gox.0000000000002873
34.
LeBretonM, CourtoisF, JournelNM, et al.Genital sensory detection thresholds and patient satisfaction with vaginoplasty in male-to-female transgender women. J Sex Med, 2017; 14(2):274–281; doi: 10.1016/j.jsxm.2016.12.005
35.
AmendB, SeiboldJ, ToomeyP, et al.Surgical reconstruction for male-to-female sex reassignment. Eur Urol, 2013; 64(1):141–149; doi: 10.1016/j.eururo.2012.12.030
36.
SalgadoCJ, GonzalezDI, WolfeEM, et al.Combined general and epidural anesthesia is associated with decreased opioid consumption and enhanced pain control after penile inversion vaginoplasty in transwomen. Ann Plast Surg, 2019; 83(6):681–686; doi: 10.1097/sap.0000000000001921
MorrisonSD, SatterwhiteT, GrantDW, et al.Long-term outcomes of rectosigmoid neocolporrhaphy in male-to-female gender reassignment surgery. Plast Reconstr Surg, 2015; 136(2):386–394; doi: 10.1097/prs.0000000000001459
39.
BoumanMB, van der SluisWB, BuncamperME, et al.Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: A prospective cohort study of surgical outcomes and follow-up of 42 patients. Plast Reconstr Surg, 2016; 138(4):614e–623e; doi: 10.1097/prs.0000000000002549
40.
DjordjevicML, StanojevicDS, BizicMR. Rectosigmoid vaginoplasty: Clinical experience and outcomes in 86 cases. J Sex Med, 2011; 8(12):3487–3494; doi: 10.1111/j.1743-6109.2011.02494.x
41.
MukaiY, SakuraiT, WatanabeT, et al.Laparoscopic rectosigmoid colon vaginoplasty in male-to-female transsexuals: Experience in Japan. Acta Med Okayama, 2019; 73(3):205–211; doi: 10.18926/amo/56862
42.
ManriqueOJ, SabbaghMD, CiudadP, et al.Gender-confirmation surgery using the pedicle transverse colon flap for vaginal reconstruction: A clinical outcome and sexual function evaluation study. Plast Reconstr Surg, 2018; 141(3):767–771; doi: 10.1097/prs.0000000000004122
43.
ÖzkanÖ, ÖzkanÖ, ÇinpolatA, et al.Vaginal reconstruction with the modified rectosigmoid colon: Surgical technique, long-term results and sexual outcomes. J Plast Surg Hand Surg, 2018; 52(4):210–216; doi: 10.1080/2000656x.2018.1444616
44.
DyGW, JunMS, BlasdelG, et al.Outcomes of gender affirming peritoneal flap vaginoplasty using the da Vinci single port versus Xi robotic systems. Eur Urol, 2021; 79(5):676–683; doi: 10.1016/j.eururo.2020.06.040
45.
CastanonCDG, MaticS, BizicM, et al.Laparoscopy assisted peritoneal pull-through vaginoplasty in transgender women. Urology, 2022; 166:301–302; doi: 10.1016/j.urology.2022.05.001
46.
KlingeleCJ, GebhartJB, CroakAJ, et al.Mcindoe procedure for vaginal agenesis: Long-term outcome and effect on quality of life. Am J Obstet Gynecol, 2003; 189(6):1569–1572; discussion 1572-1573; doi: 10.1016/s0002-9378(03)00938-4
47.
Özyazganİ, YontarY, AygenEM, et al.Use of infragluteal folds as a full-thickness skin graft donor site for construction of the neovagina in cases of mullerian agenesis. J Obstet Gynaecol Res, 2018; 44(10):1985–1994; doi: 10.1111/jog.13752
48.
GariA. Mclndoe neovagina in patients with Mullerian agenesis: A single center experience. Pak J Med Sci, 2017; 33(1):236–240; doi: 10.12669/pjms.331.11867
49.
AvinoA, RăducuL, TulinA, et al.Vaginal reconstruction in patients with Mayer-Rokitansky-Küster-Hauser syndrome-one centre experience. Medicina (Kaunas), 2020; 56(7):327; doi: 10.3390/medicina56070327
50.
ThabetSM, AliAH. New attempt using labio-vestibular flap technique to manage circumcised women with Rokitansky syndrome. Acta Obstet Gynecol Scand, 2008; 87(1):94–98; doi: 10.1080/00016340701778922
51.
RudraS, MehtaSK, HarkiranpreetKK, et al.Vaginoplasty: An innovative method of making the mould. J Clin Diagnos Res, 2018; 12(1):QC08–QC11; doi: 10.7860/jcdr/2018/27609.11053
52.
MottaGL, TavaresPM, BurttetLM, et al.Vaginoplasty with full-thickness mesh skin graft for vaginal agenesis. Urology, 2016; 98:200–203; doi: 10.1016/j.urology.2016.08.006
53.
AknS. Experience with neovaginal construction using the full-thickness skin graft in vaginal agenesis. Ann Plast Surg, 2004; 52(4):391–396; discussion 397; doi: 10.1097/01.sap.0000099707.45860.d7
54.
CheikhelardA, BidetM, BaptisteA, et al;French MRKH Study Group. Surgery is not superior to dilation for the management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome: A multicenter comparative observational study in 131 patients. Am J Obstet Gynecol, 2018; 219(3):281.e1–e281; doi: 10.1016/j.ajog.2018.07.015
55.
ZhongCX, WuJX, LiangJX, et al.Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis. Chin Med J (Engl), 2012; 125(2):203–208.
56.
ImparatoE, AlfeiA, AspesiG, et al.Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients. Int Urogynecol J Pelvic Floor Dysfunct, 2007; 18(12):1465–1469; doi: 10.1007/s00192-007-0358-0
57.
DelshadS, DelshadB, MogheimiP. Postoperative outcomes of sigmoid colon vaginoplasty for vaginal agenesis: A randomized controlled trial. Ann Med Surg (Lond), 2022; 78:103833; doi: 10.1016/j.amsu.2022.103833
58.
Erman AkarM, ÖzkanÖ, ÖzkanÖ, et al.Sexual function and long-term results following vaginal reconstruction with free vascular jejunal flap. J Sex Med, 2013; 10(11):2849–2854; doi: 10.1111/jsm.12274
59.
NowierA, EsmatM, HamzaRT. Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development. Int Braz J Urol, 2012; 38(3):380–386; discussions 387-388; doi: 10.1590/s1677-55382012000300011
60.
KaratekeA, HalilogluB, ParlakO, et al.Intestinal vaginoplasty: Seven years’ experience of a tertiary center. Fertil Steril, 2010; 94(6):2312–2315; doi: 10.1016/j.fertnstert.2010.01.004
61.
CaiB, ZhangJR, XiXW, et al.Laparoscopically assisted sigmoid colon vaginoplasty in women with mayer-rokitansky-kuster-hauser syndrome: Feasibility and short-term results. BJOG, 2007; 114(12):1486–1492; doi: 10.1111/j.1471-0528.2007.01514.x
62.
ZhangM, LiS, HuangX, et al.Transumbilical single-incision laparoscopic vaginoplasty hybrid transperineal approach using a sigmoid colon segment: Initial twenty-five cases. Int Urol Nephrol, 2016; 48(9):1401–1406; doi: 10.1007/s11255-016-1321-0
63.
Del RossiC, AttanasioA, Del CurtoS, et al.Treatment of vaginal atresia at a missionary hospital in Bangladesh: Results and followup of 20 cases. J Urol, 2003; 170(3):864–866; doi: 10.1097/01.ju.0000081425.66782.c7
64.
CommunalPH, Chevret-MeassonM, GolfierF, et al.Sexuality after sigmoid colpopoiesis in patients with Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril, 2003; 80(3):600–606; doi: 10.1016/s0015-0282(03)00796-9
65.
CaoL, WangY, LiY, et al.Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis. Int Urogynecol J, 2013; 24(7):1173–1179; doi: 10.1007/s00192-012-1991-9
66.
WangJ, WeiG, YiZ, et al.Total laparoscopic sigmoid vaginoplasty: A novel therapeutic approach. ANZ J Surg, 2021; 91(1–2):E20–E24; doi: 10.1111/ans.15786
67.
MoudouniS, KoutaniA, AttyaAI, et al.The use of isolated sigmoid colon segment for vaginal replacement in young adults. Int Urol Nephrol, 2004; 36(4):567–571; doi: 10.1007/s11255-004-0861-x
68.
ZhouJH, SunJ, YangCB, et al.Long-term outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome. Fertil Steril, 2010; 94(6):2281–2285; doi: 10.1016/j.fertnstert.2010.02.010
69.
ZhaoXW, MaJY, WangYX, et al.Laparoscopic vaginoplasty using a single peritoneal flap: 10 years of experience in the creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Fertil Steril, 2015; 104(1):241–247; doi: 10.1016/j.fertnstert.2015.04.014
70.
WuJ, GuoR, ChuD, et al.Comparison of two techniques of laparoscopy-assisted peritoneal vaginoplasty. J Minim Invasive Gynecol, 2016; 23(3):346–351; doi: 10.1016/j.jmig.2015.10.015
71.
MarquesHdS, dos SantosFL, Lopes-CostaPV, et al.Creation of a neovagina in patients with Rokitansky syndrome using peritoneum from the pouch of Douglas: An analysis of 48 cases. Fertil Steril, 2008; 90(3):827–832; doi: 10.1016/j.fertnstert.2007.07.1321
72.
ZhouQ, ZhangX, LiY, et al.Comparison of sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa graft and laparoscopic peritoneal vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Int Urogynecol J, 2023; 34(2):499–505; doi: 10.1007/s00192-022-05163-z
73.
DingJX, ChenLM, ZhangXY, et al.Sexual and functional outcomes of vaginoplasty using acellular porcine small intestinal submucosa graft or laparoscopic peritoneal vaginoplasty: A comparative study. Hum Reprod, 2015; 30(3):581–589; doi: 10.1093/humrep/deu341
LiuX, LiuM, HuaK, et al.Sexuality after laparoscopic peritoneal vaginoplasty in women with Mayer-Rokitansky-Kuster-Hauser syndrome. J Minim Invasive Gynecol, 2009; 16(6):720–729; doi: 10.1016/j.jmig.2009.07.018
76.
FedeleL, FrontinoG, RestelliE, et al.Creation of a neovagina by Davydov’s laparoscopic modified technique in patients with Rokitansky syndrome. Am J Obstet Gynecol, 2010; 202(1):33.e1–e6; doi: 10.1016/j.ajog.2009.08.035
77.
GiannesiA, MarchioleP, BenchaibM, et al.Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia. Hum Reprod, 2005; 20(10):2954–2957; doi: 10.1093/humrep/dei152
78.
UncuG, ÖzerkanK, AtaB, et al.Anatomic and functional outcomes of paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty technique in patients with Mayer-Rokitansky-Küster-Hauser syndrome: Uncu modification. J Minim Invasive Gynecol, 2018; 25(3):498–506; doi: 10.1016/j.jmig.2017.10.015
79.
YangX, ZhuL, WangYJ, et al.Comparison of the modified laparoscopic Vecchietti and Davydov colpoplasty techniques in Mayer-Rokitansky-Küster-Hauser syndrome: A long-term follow-up analysis. J Obstet Gynaecol Res, 2022; 48(7):1930–1937; doi: 10.1111/jog.15262
80.
KriplaniA, KarthikSDS, KriplaniI, et al.Laparoscopic peritoneal vaginoplasty for Mayer–Rokitansky–Küster–Hauser syndrome: An experience at a tertiary care center. J Gynecol Surg, 2018; 34(2):63–67; doi: 10.1089/gyn.2017.0076
81.
MaY, QinR, BiH, et al.The use of peritoneal tissue mobilised with a novel laparoscopic technique to reconstruct a neovagina. J Plast Reconstr Aesthet Surg, 2009; 62(3):326–330; doi: 10.1016/j.bjps.2007.11.006
82.
CandianiM, VanniVS, PapaleoE, et al.Oocyte retrieval during laparoscopic vaginoplasty to reduce invasiveness in the treatment of Mayer-Rokitansky-Küster-Hauser syndrome. J Minim Invasive Gynecol, 2020; 27(1):74–79; doi: 10.1016/j.jmig.2019.02.023
83.
BianchiS, BerlandaN, BrunettiF, et al.Creation of a neovagina by laparoscopic modified Davydov vaginoplasty in patients with partial androgen insensitivity syndrome. J Minim Invasive Gynecol, 2017; 24(7):1211–1217; doi: 10.1016/j.jmig.2017.08.006
84.
HuangZ, LiuP, LuoG. Comparison of improved laparoscopic peritoneal vaginoplasty and gasless laparoscopic ileal vaginoplasty in treatment of androgen insensitivity syndrome. Arch Gynecol Obstet, 2014; 290(4):691–696; doi: 10.1007/s00404-014-3250-4
85.
TakahashiK, NakamuraE, SuzukiS, et al.Laparoscopic Davydov procedure for the creation of a neovagina in patients with Mayer-Rokitansky-Kuster-Hauser syndrome: Analysis of 7 cases. Tokai J Exp Clin Med, 2016; 41(2):81–87.
86.
AllenLM, LuccoKL, BrownCM, et al.Psychosexual and functional outcomes after creation of a neovagina with laparoscopic Davydov in patients with vaginal agenesis. Fertil Steril, 2010; 94(6):2272–2276; doi: 10.1016/j.fertnstert.2010.02.008
87.
WangL, ZhouB, ZhaoZ, et al.Body-mass index and obesity in urban and rural China: Findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021; 398(10294):53–63; doi: 10.1016/s0140-6736(21)00798-4
88.
OakkarEE, StevensJ, TruesdaleKP, et al.BMI and all-cause mortality among Chinese and caucasians: The people’s republic of China and the atherosclerosis risk in communities studies. Asia Pac J Clin Nutr, 2015; 24(3):472–479; doi: 10.6133/apjcn.2015.24.3.12
89.
KlaverM, de BlokCJM, WiepjesCM, et al.Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: Results from a multicenter prospective study. Eur J Endocrinol, 2018; 178(2):163–171; doi: 10.1530/eje-17-0496
90.
Al-MulhimAS, Al-HussainiHA, Al-JalalBA, et al.Obesity disease and surgery. Int J Chronic Dis, 2014; 2014:652341; doi: 10.1155/2014/652341
91.
Fan ChiangYH, LeeYW, LamF, et al.Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study. Int Wound J, 2023; 20(2):391–402; doi: 10.1111/iwj.13887
92.
WaniMM, MirSA. Chronic kidney disease in Mayer-Rokitansky-Kuster-Hauser syndrome. Indian J Nephrol, 2010; 20(4):214–216; doi: 10.4103/0971-4065.73447
93.
SoedjanaH, HasibuanLY, SeptianiGA, et al.Case report in experience with neovaginal reconstruction using the inverted y flap in Mayer-Rokitansky-Küster-Hauser syndrome and androgen insensitive syndrome: A pilot study. Int J Surg Open, 2018; 15:46–50; doi: 10.1016/j.ijso.2018.10.001
94.
SanghaR, BossickA, SuWK, et al.A prospective study of patterns of regret in the year after hysterectomy. J Patient Cent Res Rev, 2020; 7(4):329–336.
95.
GrzybowskaME, FutymaK, KusiakA, et al.Colpocleisis as an obliterative surgery for pelvic organ prolapse: Is it still a viable option in the twenty-first century? Narrative review. Int Urogynecol J, 2022; 33(1):31–46; doi: 10.1007/s00192-021-04907-7
96.
MisalM, GirardoM, WassonMN. Surgical decision regret in women pursuing surgery for endometriosis or chronic pelvic pain. J Minim Invasive Gynecol, 2021; 28(7):1343–1350; doi: 10.1016/j.jmig.2020.09.016
97.
ShimamuraY, FujikawaA, KubotaK, et al.Perforation of the neovagina in a male-to-female transsexual: A case report. J Med Case Rep, 2015; 9:24; doi: 10.1186/1752-1947-9-24
98.
SuetersJ, GroenmanFA, BoumanM, et al.Vaginoplasty for gender dysphoria and Mayer–Rokitansky–Küster–Hauser syndrome: A systematic review. Am Soc Reprod Med, 2023; 4(4):219–236; doi: 10.1016/j.xfnr.2023.10.002
99.
SugrueCM, JoyceCW, CarrollSM. Levels of evidence in plastic and reconstructive surgery research: Have we improved over the past 10 years? Plast Reconstr Surg Glob Open, 2019; 7(9):e2408; doi: 10.1097/gox.0000000000002408
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