Beyond the Cutoff: Outcomes After Sigmoid Colon Vaginoplasty in Patients With BMI ≥35

Abstract

Background: Sigmoid colon vaginoplasty is a gender-affirming procedure offering a self-lubricating neovagina with adequate depth. However, the impact of BMI on sigmoid colon vaginoplasty outcomes remains unclear.

Objective: To evaluate the effect of elevated BMI on short- and medium-term postoperative outcomes in patients undergoing sigmoid colon vaginoplasty.

Design: Retrospective cohort study.

Setting: Single-institution study conducted at a tertiary academic medical center.

Patients: Transgender and non-binary patients who underwent sigmoid colon vaginoplasty between December 2020 and February 2024 with a minimum of six months postoperative follow-up. Patients were stratified into BMI ≥35 kg/m2 (obese) and BMI <35 kg/m2 (non-obese) cohorts.

Interventions: Sigmoid colon vaginoplasty, performed by senior surgeons using robotic-assisted techniques. No additional interventions were tested.

Main outcome measures: Operative time, length of stay, time to mobilization and dilation, short- and medium-term postoperative complications, reoperation, and revision rates.

Results: A total of 119 patients (median age 33 years) were included, with 29 (24.4%) classified as obese. Obese patients had significantly higher BMI (37.3 vs. 26.7, p < 0.001) and ASA III classification (20.7% vs. 4.4%, p = 0.006). There were no significant differences in operative time (203 vs. 188.5 min, p = 0.277), hospital stay, or mobilization. Patients with BMI ≥35 had higher but nonsignificant rates of short-term complications (24.1% vs. 15.6%, p = 0.292), including bowel injury and dehiscence. Medium-term complications, such as vaginal prolapse, stenosis, reoperation, and revision vaginoplasty, were similar between groups.

Limitations: Single-center retrospective design with limited obese patient sample size and absence of long-term functional outcomes.

Conclusions: Although differences were not statistically significant, patients with BMI ≥35 demonstrated higher complication rates, suggesting a potential trend that warrants further investigation. Sigmoid colon vaginoplasty appears safe in appropriately selected patients across BMI categories, but individualized risk assessment and close perioperative monitoring are advised, particularly in higher-BMI individuals. See Video Abstract.

Keywords: Body mass index; Gender-affirming surgery; Obesity; Postoperative complications; Sigmoid colon vaginoplasty; Transgender health.