127. Gender-Affirming Sigmoid Colon Vaginoplasty: Does BMI Impact Outcomes?

PURPOSE: Sigmoid colon vaginoplasty (SCV) is an alternative to penile inversion vaginoplasty (PIV) for transgender and non-binary (TGNB) individuals seeking genital reconstruction. SCV offers benefits such as a self-lubricating neovaginal canal with adequate length and low rates of complications. However, the impact of body mass index (BMI) on outcomes following SCV is not well understood. This study evaluates how BMI influences short- and long-term postoperative outcomes in patients undergoing SCV. METHODS: We conducted a single-center retrospective review of TGNB patients who underwent SCV between December 2020 and February 2024. Patients were divided into two cohorts: BMI ≥35 kg/m² (obese) and BMI <35 kg/m² (non-obese). Demographic data, perioperative details, and postoperative outcomes were analyzed and compared between groups. Short-term complications were defined as occurring within 30 days of surgery, and long-term complications were those occurring after 30 days. RESULTS: A total of 99 patients underwent SCV, with a median age of the cohort was 33 (IQR:10) years. Of the population, 23 patients (23.2%) were classified as obese (BMI ≥35), with a median BMI of 37.3 kg/m² compared to 26.1 kg/m² for the non-obese group (p < 0.001). Obese patients had a higher American Society of Anesthesiologists (ASA) class, with 26.1% classified as ASA III compared to 5.3% in the non-obese group (p = 0.007). There were no differences in smoking status and despite 92 (92.9%) individuals using hormone therapy, both the type and duration of hormone therapy did not significantly differ between groups. Although the duration of surgery was longer in obese patients (median 212 vs. 194 minutes, p = 0.470), this difference was not statistically significant. Hospital length of stay, time to mobilization, and time to dilation were similar between groups. Short-term complications were slightly higher in the obese group (26.1% vs. 18.4%, p = 0.422), including higher rates of bowel injury (8.7% vs. 1.3%, p = 0.134) and dehiscence (13.0% vs. 7.9%, p = 0.430), though these differences were not statistical significance. Long-term complications, such as vaginal prolapse (13.0% vs. 14.5%, p = 1.000) and vaginal stenosis (13.0% vs. 10.5%, p = 0.714), were comparable between groups. Overall, 17.4% of obese patients required re-operation for prolapse or stenosis revision, which was similar to the non-obese group (17.1%, p = 1.000). CONCLUSION: BMI does not appear to significantly impact long-term outcomes following SCV, although obese patients may experience a slightly higher rate of short-term complications. Despite the increased operative time and higher ASA class among obese patients, the rates of complications, including vaginal prolapse and stenosis, were comparable to those of non-obese patients. SCV remains a safe and viable option for TGNB individuals, regardless of BMI, with close postoperative monitoring recommended for those in the obese cohort.