Introduction: Vaginectomy is an essential part of many masculinizing genital gender affirming surgeries. Multiple techniques have been developed including mucosal fulguration and vaginal excision, either laparoscopic or transvaginal. Reports of outcomes and complications related to these procedures are limited. This study aims to describe the outcomes and complications related to vaginal excision vaginectomy performed at our institution. We also evaluated associations with blood loss and operative time. Methods: This is a case series of 117 patients who underwent gender affirming vaginectomy from September 2016 to February 2022. We collected intraoperative data (primary procedure, estimated blood loss, total vaginal length, genital hiatus length, operative time) and health information from the medical records including age and BMI. Results: Vaginectomy was always performed with another primary surgery including phalloplasty (n=67, 57%), metoidioplasty (n=48, 41%), and other surgeries (n=2, 2%). Median age of patients was 35 years (range: 17-67); median BMI was 23.6 (range: 18.3-40.2). Median blood loss was 200 ml (range: 20-1500 ml). Over time, EBL did not differ significantly, but case time decreased significantly with increased number of cases, indicative of a learning curve. Average operative time was 195 minutes for the first 10 cases and 145 minutes for most recent 10 cases (p=0.03). Higher EBL was associated with longer operative time (p < 0.0001), higher BMI (p < 0.0001), and longer total vaginal length (p=0.002). Increased operative time was associated with higher BMI (p=0.0001), and longer total vaginal length (p < 0.0001). Complications included need for blood transfusion (2%), perineal wound infection requiring incision and drainage with antibiotics (3%), wound infection without need for procedural management (5%), and cystotomy requiring cystorraphy (1%). No mucoceles or fistulas to the vaginal space were seen among our patients with an average follow-up period of 306 days. Conclusions: Gender affirming vaginectomy among our cohort was found to be a safe procedure with low perioperative and long-term complications. Operative time decreased with the surgeon performing more cases. Patients with higher BMI or longer total vaginal length require longer operative times for and have more blood loss during this surgery. SOURCE OF Funding: None
