Abstract

ABSTRACT
Background: Peritoneal vaginoplasty has re-emerged as an alternative technique in transfeminine gender-affirming surgery due to its potential advantages over penile inversion and skin graft methods. However, variable techniques, complication rates, and long-term outcomes raise important clinical considerations.
Objective: To review and synthesize the available literature on peritoneal vaginoplasty in transgender women and provide personal perspectives on its anatomical challenges, technique-specific risks, and long-term implications.
Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science. Studies describing peritoneal vaginoplasty in transgender women were included. Non-surgical studies, MRKH cases, review articles, and unclear techniques were excluded. Techniques, vascular supply, complications, and outcomes were analyzed.
Results: Fifteen studies published between 2015 and 2025 met the inclusion criteria. Techniques included double-flap pull-through approaches, three-flap techniques, pedicled peritoneal flaps, and extended posterior bladder flaps. Reported complications included hypergranulation, neovaginal stenosis, difficulty with dilation, and rare intra-abdominal hernias. Outcomes varied widely depending on flap design and anastomotic tension.
Conclusion: Peritoneal vaginoplasty offers a viable but technically challenging option for transgender women. Differences in epithelial interface (peritoneum-to-skin) influence healing and complication profiles. Posterior bladder-based flaps may provide the most reliable outcomes. Long-term, high-quality comparative studies are needed.