Sigmoid Colon/ Rectosigmoid Vaginoplasty/ Rectosigmoid Colon, Sex Reassigment Surgery, Sex Change, SRS

Sigmoid Colon/ Rectosigmoid Vaginoplasty/ Rectosigmoid Colon

Surgical fee


		- Pre-surgery night, five nights recuperation in hospital - Doctor's fee - Clinical interview/surgical consultation - Psycho logic (if necessary not included) - Surgical and anesthesia fee (surgical not include if you have medical diseases such as EG, diabetes, mellitus, heart diseases which is this cover during pre-op check up)

	Post Operative Care
		- Included all medical treatments and supplies as a package such as cushion ring Invalid Rbr, Syringe Ball, Betadine Solution, Banocin Powder, K-Y Lubricating Jelly, Candle Dilator, Comdom and etcs. - Five nights free of charged after surgery in hospital private room. - Postoperative check-up at the Institute during recuperation

	GRS (or SRS) Certification
		GRS/SRS Certification

	Guaranteed Satisfaction
		- No doctor's fee if any corrections are required - All post-operatives after care are provided without cost

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Fact about procedure

		Some brife information on Penile Skin Inversion technique and Sigmoid Colon. What's diferent between Penile Skin Inversion verse Sigmoid Colon?.The technique used is Penile Skin Invertion, the sensational glans clitoris, labiaplasty and vaginoplasty in one stage with 3 different technique: 1. Penile Skin Inversion (PSI) only for the long penis(>6inches) 2. Penile Skin Inversion(PSI) with Scrotal Skin Graft(SSG) for medium size penis(2-6 inches) 3. Penile Skin Inversion(PSI) with Sigmoid Color Graft(SCG) for Tiny, small size penis(<2 inches) Conclusion, Penile Skin Inversion with Sigmoid Colon is US$8,400 and the PSI plus SCG are done in one stage with 5days hospitalization (Average)

	Criteria of Approval
		- Vaginal stenosis, shortening after SRS. [So called secondary operation] - Very short penile skin (less than one inch) [So called Primary Rectosigmoid Vaginoplasty] - The patient is healthy and not over weighed. Surgery is performed by Dr. Preecha Tiewtranon M.D., Plastic and Reconstructive Surgeon, American Board Certified in 1973, Associate Professor and former Chairman of Plastic and Reconstructive Surgery in the King Chulalongkorn University, Faculty of Medicine in Bangkok, Thailand, also the former President of the Society of Plastic and Reconstructive Surgeons of Thailand and President of the Society of Aesthetic Surgeons of Thailand, Member of the International Society of Plastic and Reconstructive Surgery.

	Surgical procedure
		The bowels are prepared mechanically. The patient is placed in lithotomy. The general surgeon and plastic surgeon operate simultaneously and the general surgeon (abdominal surgeon) prepares the bowel through the short low Pfannenstiel incision. The sigmoid colon is isolated about 15-20 cms in length, with the vascular pedicle from the inferior mesenteric and superior hemorrhoidal system, the remaining two ends of the colon is anastomosed by the continuous, one layer closure. The plastic surgeon starts the perineal dissection by transversely incising the end pouch of the penile skin or the end of vaginal mucosa in the case of vaginal astresia. The dissection is carried out by eletrocautery, by palpating the urethral catheter anterior up to the retrobladder properitoneal space and the peritoneum is incised and enlarged. The general surgeon deliver the colon through the peritoneal opening after closing the proximal end, generally the rectosigmoid opening could be pulled down to the perineal skin without any tension, the anastomosis is made to the vaginal skin cuff at 1- 2 inches from the perineum, using the interrupted chronic catgut.

	Results
		Advantages: 1. Self-lubricated 2. Early sexual intercourse. 3. Very long length of vagina can accommodate penis to 8 – 10 inches. 4. Very rarely contracted or stenosed if very well cares. Disadvantages: 1. Extracost due to one more abdominal surgeon to open the abdomen. 2. Higher risks of abdominal and bowel surgery, can be serious in the inexperienced surgeon. 3. Need more experienced surgeon. 4. Excessive mucous discharge, swelly in the first 6 month. We are enclosing the publication which was published in Text Book Plastic Surgery - 1992 as supportive evidence. The demands of Rectosigmoid Vaginoplasty seem to increase due to the better satisfying sexual intercourse pleasure of male partners

	Duration of Operation:
		The operation takes about 2.30-3.00 hours.

	Possible Risks and Complications
		Usually there is no wound infection, no intra abdominal complications, such as infection, peritonitis, obstruction, ileus, leakage of the anastomosis. Up to year 2002, we have found only one patient developed circumferential stricture which were corrected by double Z plasties, all patients are lubricated vaginal canal. The mucous discharge is usually excessive during the first few months and later subsided. The vaginal atresia patients menstruate through the newly constructed colonic vagina and the short low Pfannenstiel incision was well camouflaged by underwear bikini. - In 162 patients, No mortality or serious intra abdominal complications such as leakage, sepsis, abcess, abstructio. - Only 1 patient had anastomosis disruption at skin level which was well taken care of 1 skin wound infection. - The mucous discharge was excessive during the first 3 months, then subsided and very well toterated.

	After Care
		The surgeon and nurse will teach you how to take care of your vagina; - The dilator is used for 15 minutes twice daily for six months - sexual intercourse is allowed after three weeks - Have to wear tampon all the time for 3 months due to exercise mucous discharge - Vaginal douche daily

	Recovery Time
		- You need to stay recuperate totally in Bangkok for 10-14 days at least before safely flying home. - You will also require 4-6 weeks recuperate at home before returning to work. - The neovagina can function within 4 weeks and Sexual intercourse can resume after 3 weeks.

	Hospital Admission
		You will be requested to sign in hospital consent form. Then you need five to seven nights admission to hospital and another five to seven days at your choosen hotel in Bangkok for recuperation.

	Anesthetic
		General anesthesia(You are Asleep) or you can choose epidural or spinal anesthesia.

	Post Operative Care
		After release from hospital the patient will recover with the aid of liaison at the hotel. During recovery in the hotel, the patient must follow patient instructions, including: Dilating is the most important thing you can do to ensure the success of your surgery. If the patient does not dialate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture. Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed. Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina. During the recovery period, after each dilation session: The wound should be washed gently with Hibiscrub (pink color) in the shower followed by douching while seated in the toilet: (i) douche solution(proportion) = 5-10 ml (cc) of Betadine solution mixed with 1L of water or until the container is full; (ii) insert the douche to full depth, squeeze, and hold tightly the container; (iii) while holding tightly the container, extract the douche; (iv) keep the wound dry and apply Betadine solution with cotton balls; and (v) apply terramycin ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine knapkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.

Preparation

	Preparation before operation
		- Need to prepare the bowel cleansing one week before surgery by daily enema, loxative - Liquid diet 3 days before surgery - Antibiotics 48 hours before surgery - Inform us about any allergies, any serious medical condition(s), and all medications you are taking (both prescription and non-prescription) - Tell your doctor if you have any serious medical condition(s) - Avoid aspirin, ibuprofen (Advil, etc) , and vitamin E for 2 weeks prior - Refrain from smoking 2 weeks before and 4 weeks after surgery - Plan to be in Thailand 10-14 days altogether - Have genital electrolysis completed to be clean at the base of the penis and center of scrotum

	Passport and Visa
		Passport; In USA, you can call San Francisco information (415) 744-4444 or you can find the number to your local passport office by looking up under “U.S. Government offices” in the white pages of your phone book, or your local office. Visa; Not required if less than 30 days in Thailand or check with your local passport office

	Flight Arrangement
		We can recommend the travel agency if you wish and Our recommended airlines are Thai International, Northwest, Lufthansa, Singapore, and EVA which has wide seats. In order for us to arrange to pick you up from the airport on arrival and departure, and reserve the hospital room for you in advance, Please inform us your flight itinerary one week in advance prior the arrival.

	Expense
		- Surgical fee is $ 8,400 (U.S.) and require $800 deposit for reservation - If you are HIV positive, then you are a risk to hospital personnel. For this reason you need to pay an extra 30% of the original charge. - Prepare cash for your personnel to stay after surgery about $20-40 (U.S.) per day for food expense. - Airport Tax on departure is $15 (U.S.) - Touring arrangements will be around $20-$100 (U.S.) per day (optional)




	Airport Immigration and Customs
		Please present the supporting documents confirming the scheduled operation upon request. Please do not carry any unnecessary drugs or dangerous objects in your luggage.

	Appointment with Surgeon
		The operation can be arranged once you have all the required papers ready. Just inform us of your convenient date at least one month in advance prior to arrival, either by click here to contact us via e-mail at inquiry@bph.co.th , or by calling us at (66) 3825-9999. Patients are required to submit following documents before operation: (Int.' Patient only) 1) e-mail scan, fax one piece of photo identification (e.g. drivers license, Passport, etc) 2) e-mail scan, fax of bank 10% wire transfers (please check at term and payment) 3) e-mail scan, fax copy of the flight reservation itinerary 4) original signed (hard-copy) documents of claimed diagnoses or referrals. We will collect your hard documents during consultation. 5) Once the applicant has been approved for Penile Skin Inversion (MtF) Surgery, the patient can then make the flight arrangement. Patient can e-mail to inquiry@bph.co.th Bangkok Pattaya Hospital 301 moo 6, Naklua, Banglamung, Chonburi 20150

	Personnel Belonging
		Please carry only essential belonging If the patient arrives alone, it is essential to travel with light luggage (max. 25 kgs) to avoid risking injury during the 4-6 week recovery period.

Surgery Schedule Detail

		Before leaving two days you have to take only liquid diet no meat and vegetable, and pass taking laxative and fleet enema daily for two days. DAY 1 - Arrive in Bangkok International Airport. Meet BPH staff and be escorted to the hospital hotel. - Pre-surgery night in the private suite in Hospital hotel DAY 2 - Meet with your appointment doctor for clinical interview/ surgical consultation. All questions will be clarified personally and the surgery technique will be discussed and interview. - Check medical documents - Doctor will prescribe antibiotics to clean the bowel for two days DAY 3 - Continue taking liquid diet, laxative, antibiotics as prescribed DAY 4 - Admission to hospital. You will be requested to sign hospital consent forms - The operation time will be set up and inform to you ON THE DAY - The nurse will do complete enema to clean rectum. - Take very nice shower. - Preoperative intravenous fluid and sedation. - In operating room under general anesthesia. Surgery takes about two and a half hour to three hours DAY 5-6 The day after; you can not have food or drink You will receive intra venous fluid and antibiotics for two days after operation DAY 7-8 Your doctor will remove the dressing and bandages. Upon checking you will start to have liquid diet progress to soft diet and discontinue the intravenous fluid. Remove the dressing and recuperate for another two to three days and will be discharge to the hotel on the fifth day after operation. DAY 9-12 You will require staying in hotel for about five days before planning to go home. The doctor will see you very closely during this time. DAY 13 You may go to Sightseeing (Depend on doctor diagnosis). Visit the hospital where the doctor will remove sutures from the labia and do a final examination. You will receive a final postoperative recovery check up and some medications. You will also receive a medical certificate that authenticates the surgery. DAY 14 Transfer to Bangkok International Airport for Departure by BPH staff.

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