Recommendations on how to prevent possible complications after Sex reassignment surgery (SRS)

1. Avoid medications that cause bleeding

Bleeding after Sex reassignment Surgery is possible; however the chance of major bleeding should be considered very low when this operation is performed by a competent and highly experienced surgeon.

At Chettawut Plastic Surgery Center, we have never experienced serious bleeding complications from the surgery and there is no case where blood transfusion is needed due to bleeding from surgery.

During Sex Reassignment Surgery (SRS), Dr.Chettawut will control and stop bleeding carefully by meticulous cauterization with an electrosurgical unit and also utilize hemostatic agents.

There are some medications or underlying diseases which might increase the risk of bleeding during SRS operation and it is important that you never conceal any known condition(s) or underlying disease(s) which might cause post-operative bleeding or complications during or after surgery.

Recommendation:

The following medications must be completely stopped at least 2 weeks prior to surgery.

-Aspirin (ASA) or Baby aspirin or any medications which contain aspirin, for example oxycodone plus aspirin (Percodan, Endodan, etc).

-Blood thinner medication, for example Coumadin (Warfarin), Pradaxa, Brilinta, Clopidogrel, Dipyridamole, Persantine, Plavix, Pletal, Ticagrelor, Ticlopidine, Ticlid, Trental, etc.

-NSAID (Non-steroidal-anti-inflammation drug), for example Advil, Celebrex, Diclofenac, Dolabid, Feldene, Ibuprofen, Indocin, Indomethacin, Mefenamic, Meloxicam, Norgesic, Piroxicam.

-Vitamin E

-Some antidepressants also known as selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine).

2. Empty your bowel completely before sex reassignment surgery to avoid wound contamination

Since Gender Reassignment Surgery is classified as clean surgery, the risk of infection is significantly low.

However the risk of infection can be increased if your bowel is not clean during operation.

Bowel movement during operation or early stages of recovery should be a good example of a situation which causes the risk of genital wound infection.

Another good example is the risk of intra-abdominal infection in colon vaginoplasty surgery, this happens when unclean bowel is cut and re-positioned during the colon graft vaginoplasty.

Dr.Chettawut implements a thorough program of bowel cleaning before sex reassignment surgery (SRS) and also colon vaginoplasty which can help reduce the chance of wound contamination and/or infection to be almost impossible.

Recommendation

Dr.Chettawut’s SRS patients require arriving in Bangkok at least 3 full days prior to SRS or colon vaginoplasty to complete the bowel cleaning program. The following is a brief of what patients can expect:

1. Patients must change the type of food from normal food to be clear liquid diet 3 days prior to SRS or colon vaginoplasty.

2. Laxative pills and Fleet enema are required on the second day prior to SRS or colon vaginoplasty.

3. Swiff (Sodium phosphate oral solution) needs to be consumed on the first day prior to SRS or colon vaginoplasty.

Note:

Swiff solution is a hyper osmotic strong laxative drug which causes urgent and recurrent movement of the bowels occurring in one to two hours’ time.

Swiff solution is so distasteful to drink; so patients should mix it with a soda drink (for example, Coca Cola or Sprite) or fruit juice into the required amount of Swiff and drink it quickly.

3. Vaginal shortening or narrowing or collapse after sex change surgery

Dr.Chettawut will always strive to create the maximum depth of your vagina.

Even though there is minor variation of depth due to individual anatomy; the average vaginal depth of standard Sex Reassignment Surgery (SRS with skin graft technique) is 6.5 inches, while the average depth of sigmoid colon vaginoplasty (SRS with colon graft technique) is 8.5 inches.

Either skin graft or colon graft technique will provide healthy tissue lining for vagina in order to accommodate dilation and successful sexual intercourse.

Vaginal shortening or collapse can happen from the shrinking of skin graft inside the vagina if the patient does not perform dilation adequately or incorrectly.

It is the patients’ full responsibility to routinely perform dilation as instructed to maintain the original depth of vagina.

Recommendation:

For the patients who have undergone SRS with skin graft technique, Dr.Chettawut emphasize on the light and constant pressure applied by the tip of the dilator against the bottom of the vagina to prevent skin-graft contraction.

For patients who have undergone SRS with colon graft technique (colon vaginoplasty), Dr.Chettawut emphasizes on the proper size of dilator (diameter 32 mm or more) to avoid ring scar contraction around the vaginal opening (junction between skin and colon mucosa).