Susan's Place Transgender Resources

Community Conversation => Transitioning => Gender Correction Surgery => Topic started by: josie76 on February 13, 2019, 06:31:53 am

Title: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 13, 2019, 06:31:53 am
In the next week my spouse is starting a job with health insurance that actually has GCS coverage!  :o :D I'm excited by this. In all my research into peritoneal vaginoplasty I found out that Dr. Gallagher at the IU Hospital in Indianapolis IN, is going to be offering a version of this procedure.

Otherwise I have been looking to PriyaMed in Mumbia as they are they only ones who have worked with surgeons to offer a version of this for transwomen. Now their doctors have created a procedure that does not use any penile inversion. I can only guess that they use the inner scrotal tissues to form the vestibule area and they connect the peritoneal tube to that.

Dr. Gallagher is working with the general surgical dept at the university hospital there and she will still use the penile inversion for the outer entry point of the vaginal canal, attaching the peritoneal tube to that.

While I find the idea of PriyaMed's version sounds very intriguing, having insurance that will cover GCS right here in the US and within a days driving distance from my home is sounding better and better. In the end it may come down to money.  :( I will have to see with this insurance, they will pay for "out of network providers" but a percentage. Then there is a $6000 max out of pocket so it comes down to how much will it cost here verses the cost of travel to India and the procedure there (around $15k).

Both providers intend on offering this fully this spring/summer.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Anna994 on February 14, 2019, 02:43:10 am
I wish you good luck! The best I can offer you is some advice considering I've had the peritoneal method done (As a revision, attached to the previous penile inversion).

Dilatation is way less intense, I do it twice a day seeing as it's been about 2.5 months since my surgery. However, very often it happens that I skip a dilatation, I've even done once a day for almost 4 or so days in a row, I didn't get any tighter at all or felt changes.

It's very wet, expect to need pantyliners, but it's not so wet that you'll need pads, the wetness coming from the peritoneum is a thin liquid, doesn't really smell like much, just smells like "wet" and at times it can have a slightly (extremely slightly) red or yellow hue, this is mostly due to it mixing with some remaining urine or blood.

As I am the very first one to have this done in my country, we have been establishing a protocol with my doctors based on my case. We've concluded that the best kind of dilator for this procedure is silicone, the peritoneum is quite fragile and doesn't require all that much dilatation. It becomes less fragile over time as it begins to morph into something ressembling vaginal tissue, but for those first 3 months, silicone dilators are very comfortable, less risky and dilate you more than enough. Do bring this up with your doc of course!

Mine was done laparoscopically, so I have laparoscopic scars, one in my belly buttons that's invisible, 3 more around it, hidden by panties, they are 1/4 inch incisions.

Anything else you might wanna know, please do hit me up I'd love to share as much info as I can <3
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 15, 2019, 06:04:00 am
Thanks Anna.
I am FB friends with one of the girls who had the pilot surgery done in Mumbia. She has been very informative on her experience. I like the idea of the way they have done the surgery, no penile inversion. In doing it that way there was none of the need to stretch and cut the skin so much.

I have concerns about the only surgeon here in the US who is offering it. I have only been able to communicate with 2 of her former patients. One is happy with her results, one has had an aweful time with scarring and not being able to get it fixed. This leaves me concerned.

I know there are patients from almost every surgeon who has problems. One lady I know personally has just returned from Montreal and still has the cathider in place. She has had some trouble finding a doctor who will remove it now. There are bad stories from Chicago. The are many, many girls who end up getting revisions just so they can pee correctly.

All of this actually makes me consider traveling to Mumbia more. I have contact with quite a few who have had surgeries there in the past and leave with everything working properly the first time. It's almost as if the surgeons there are more careful than those here in the US.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 16, 2019, 06:53:01 am
As an update,

I have been able to hear from 4 more patients of Dr. Gallagher through Facebook. All were happy with their results, doctor, and staff. Seems the patient coordinator that caused issues for some in the past is long gone now. One lady said 2 of her friends are scheduled to have Dr. Gallagher do their GCS later this year.

I know one member here who previously reach out and shared her blog with her extremely negative results and interactions with that practice. Is there anyone else on here with either positive or negative experiences?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: chinee on February 19, 2019, 02:19:51 pm
I wish you good luck! The best I can offer you is some advice considering I've had the peritoneal method done (As a revision, attached to the previous penile inversion).

Dilatation is way less intense, I do it twice a day seeing as it's been about 2.5 months since my surgery. However, very often it happens that I skip a dilatation, I've even done once a day for almost 4 or so days in a row, I didn't get any tighter at all or felt changes.

It's very wet, expect to need pantyliners, but it's not so wet that you'll need pads, the wetness coming from the peritoneum is a thin liquid, doesn't really smell like much, just smells like "wet" and at times it can have a slightly (extremely slightly) red or yellow hue, this is mostly due to it mixing with some remaining urine or blood.

As I am the very first one to have this done in my country, we have been establishing a protocol with my doctors based on my case. We've concluded that the best kind of dilator for this procedure is silicone, the peritoneum is quite fragile and doesn't require all that much dilatation. It becomes less fragile over time as it begins to morph into something ressembling vaginal tissue, but for those first 3 months, silicone dilators are very comfortable, less risky and dilate you more than enough. Do bring this up with your doc of course!

Mine was done laparoscopically, so I have laparoscopic scars, one in my belly buttons that's invisible, 3 more around it, hidden by panties, they are 1/4 inch incisions.

Anything else you might wanna know, please do hit me up I'd love to share as much info as I can <3

Im interested with this kind of revision as I have done penile inversion  5 years ago.

my question is how soon can you have sexual intercourse after the peritoneum revision? Im worried that it is very fragile and being sexually active.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Anna994 on February 19, 2019, 05:28:11 pm
Sadly, I am my doctor's first patient. We're being very careful and waiting for the 6 months mark before sexual activity. I'll deffo update my own topic once it happens with all of the information.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 20, 2019, 04:52:00 pm
I know a girl on FB who was one of the three to get the pilot surgery in Mumbia with PriyaMed. I think she mentioned it was around the 3 month mark or so. One of their patients let them do a biopsy and at 3-4 months the peritoneal vaginal lining is indistinguishable from cis vaginal lining tissue under a microscope. This was something that earlier studies on cis-girls with Mullerian agenesis had shown as well.

I have been emailing with Dr. Gallagher's PA. Dr. Gallagher is open to discussing doing it without penile inversion so I'm pretty happy hearing that. I hope to have my second WPATH letter next week. Then its up to finding out how well this new insurance is going to be.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 20, 2019, 05:05:31 pm
Sadly, I am my doctor's first patient. We're being very careful and waiting for the 6 months mark before sexual activity. I'll deffo update my own topic once it happens with all of the information.

Anna, did you have to use an estrogen cream vaginally for the first three months?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Anna994 on February 21, 2019, 10:43:59 am
No, I wasn't instructed to use an estrogen cream ^^
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Kaley on March 06, 2019, 05:34:36 am
Wow, thanks for all the info!
What was the best way to get in contact with Dr. Gallagher’s office?  I’m in Hawaii so calling is always hard to arrange.  I filled out the form at  (https://universitygenderaffirmationsurgery.com/contact) but wasn’t sure if there was a more direct route?

I’m actually scheduled for surgery with Dr. Bowers soon (seems like I’ve been on her wait list for forever now...), but am really intrigued by the peritoneal method.
I haven’t seen/heard from many other previous patients who have had this procedure, but it seems like overall feedback has been pretty good!
I guess I’m having second thoughts about the standard surgical procedure and don’t want to go through multiple surgeries if I don’t need to.
Alright, well please keep us updated!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on March 07, 2019, 08:06:05 am
That online form is the simplest way. That or their generic email askus@universitygenderaffirmationsurgery.com. Emma is the new patient coordinator. She gave me a direct email to send my letters to her.

So at this point I have sent:
my first letter from therapist, masters degree, long term relationship
my hormone therapy letter from my endocrinologist
a copy of my new insurance transgender policy from their web site
a copy of my new insurance card
My second therapist is supposed to send her letter directly

Now I wait to see what they figure out. After verifying insurance coverage they should contact me and let me schedule a consultation appointment. After this happens I will know more.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: thebeardedlady on March 19, 2019, 06:11:14 pm
Best of luck! I am interested in having this procedure done and hope to hear great news about your experience.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Ann W on March 19, 2019, 10:49:46 pm
@josie76

Thank you for sharing your experience.

I like what I've heard about this procedure; and my sister lives in Indianapolis, which means I will have help if Dr. Gallagher does my surgery. I will be following your progress closely.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on March 20, 2019, 07:03:01 am
Well my second therapist did not directly send the letter but I am meeting with her later today to pick it up. Then I can send it on. I have not heard anything back about my insurance as of yet.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: gracefulhat on March 20, 2019, 08:22:48 am
Thank you!!!!!!! For posting this thread. I know multiple grs patients of Dr. Galligar who are pleased. I will be able to be placed on her waiting list this August and had recently seen Dr. Galligar YouTube video discussing the peritoneal vaginoplasty which seems more ideal to a cis vagina. I didn't realize she would be offering this so soon and it makes me so relieved. Also, didn't Jazz Jennings surgeon perform a peritoneal vaginoplasty for her since she lacked tissue?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on March 20, 2019, 07:35:05 pm
Thank you!!!!!!! For posting this thread. I know multiple grs patients of Dr. Galligar who are pleased. I will be able to be placed on her waiting list this August and had recently seen Dr. Galligar YouTube video discussing the peritoneal vaginoplasty which seems more ideal to a cis vagina. I didn't realize she would be offering this so soon and it makes me so relieved. Also, didn't Jazz Jennings surgeon perform a peritoneal vaginoplasty for her since she lacked tissue?

So there is a huge misconception about what is a peritoneal vaginoplasty.
 
Dr. Ting used Peritoneal like tissue from the scrotum to stitch inside of an inverter penile vaginoplasty. Not the same.

A number of doctors will use scrotal skin with this same type of tissue still connected to form the bottom part of a penile inversion as a standard practice. However you still have a length of regular penile skin first. Also neither surgical style does away with internal scar issues when healing.

I know one lady here who had a partial true Peritoneal vaginoplasty some years ago as a revision surgery to correct lost depth done by Dr. Bluebond-Langer.

So what we are really talking about is a true Pull through peritoneal vaginoplasty. This is done with the Peritoneal pouch inside the abdomen. Now Dr. Gallagher's plan was to still use penile inversion with the peritoneal tissues connected inside. This would be like the revision done by Dr. Bluebond-Langer and the Dr. in Serbia.
What we are talking about is a laproscopic Davydov Method vaginoplasty with full exterior reconstruction. This is what has not been done before last year in India. I have found cases published where a PAIS girls had it done where they had "ambiguous genitalia" so a reconstruction but with less than functional male genitals to start with.

I think the theory is fine. It's just getting doctors to actually do this procedure for us that is the issue.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Ann W on March 20, 2019, 09:45:37 pm
@josie76

Have you been filled in yet on Dr. Gallagher's standard pre-operative requirements? Some surgeons require a lengthy program of electrolysis, for example. I'd like to make sure I complete all her requirements so that I am ready to go as early as possible, once I have the money and, of course, am accepted as a surgical candidate.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 04, 2019, 06:14:40 am
@josie76

Have you been filled in yet on Dr. Gallagher's standard pre-operative requirements? Some surgeons require a lengthy program of electrolysis, for example. I'd like to make sure I complete all her requirements so that I am ready to go as early as possible, once I have the money and, of course, am accepted as a surgical candidate.

So Dr. Gallagher used to require clearing of hair. Now she does not.

I am finally on the schedule for a consultation at the end of the month! I will know more after that.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AnonyMs on April 04, 2019, 04:55:04 pm
So Dr. Gallagher used to require clearing of hair. Now she does not.

She has a YouTube video where she discusses hair removal where she basically says she doesn't recommend it because it doesn't work, not because its not needed.

Also, there's a new patient post on realself with photo's and all. Its not good.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 05, 2019, 05:40:59 pm
That's the same patient that had such a bad time with her. Awfull for her but she seems like the only one I can find who had such a result. IDK why. She has written her story several places. I can understand why she does, but again she seems to be the only one. Terrible to be stuck in her situation.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: krobinson103 on April 10, 2019, 04:09:49 pm
I'm in the process of arranging the procedure in India (I live in New Zealand so travel for surgery is a necessity). For me talking to various people and comparing it with penile inversion it seems a no brainer. Just a better surgery all round.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AnonyMs on April 10, 2019, 08:14:34 pm
It's quite difficult to find any information on Indian surgeons, even on an Indian forum I looked at. It seems they aspire to go to Thailand.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 13, 2019, 06:34:30 am
The procedure krobinson is talking about is PriyaMed's. It is based out of the University hospital in Mumbia and done by urologynocologists trained with Dr. Mahtre's version of the Davydov Method.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 23, 2019, 07:44:03 am
I go see Dr. Gallagher this Friday. I will have more information after that consult appointment.
Hopefully good news. Fingers crossed.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maybebaby56 on April 28, 2019, 08:07:35 am
I wish you good luck! The best I can offer you is some advice considering I've had the peritoneal method done (As a revision, attached to the previous penile inversion).

Dilatation is way less intense, I do it twice a day seeing as it's been about 2.5 months since my surgery. However, very often it happens that I skip a dilatation, I've even done once a day for almost 4 or so days in a row, I didn't get any tighter at all or felt changes.

It's very wet, expect to need pantyliners, but it's not so wet that you'll need pads, the wetness coming from the peritoneum is a thin liquid, doesn't really smell like much, just smells like "wet" and at times it can have a slightly (extremely slightly) red or yellow hue, this is mostly due to it mixing with some remaining urine or blood.

As I am the very first one to have this done in my country, we have been establishing a protocol with my doctors based on my case. We've concluded that the best kind of dilator for this procedure is silicone, the peritoneum is quite fragile and doesn't require all that much dilatation. It becomes less fragile over time as it begins to morph into something ressembling vaginal tissue, but for those first 3 months, silicone dilators are very comfortable, less risky and dilate you more than enough. Do bring this up with your doc of course!

Mine was done laparoscopically, so I have laparoscopic scars, one in my belly buttons that's invisible, 3 more around it, hidden by panties, they are 1/4 inch incisions.

Anything else you might wanna know, please do hit me up I'd love to share as much info as I can <3

This is very good to know. Thank you for posting this. I am having a peritoneal graft done as a revision as well. My surgery is scheduled for next March with Dr. Bluebond-Langner at NYU.

How long ago did you have your original vaginoplasty?  Mine was in August of 2017. I had quite a few complications leading to dyspaneuria and stenosis. Pelvic floor physical therapy has helped some. I only dilate about once a week now, but I haven't lost any further size to my vaginal canal.

I hope you continue to post your results.

With kindness,

Terri
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 29, 2019, 01:31:00 am
Well first I want to say Dr. Gallagher is pretty awesome!

We discussed potential options. Heck she got a pen and paper and we sketched out different possible ways to do the external parts depending on how the internal was done. She was super receptive to my concerns and ideas as I have been studying the medical journals about this for some time.

Now then, her only issue is needing a urologist/gynourologist who will agree to do the Peritoneal pull through method. (Davydov Method). Doctors have a habit of being stuck in their ways. She has been reaching out to several in the IU hospital system. Most have told her the procedure won't work on a male pelvis because it would be deeper and narrower than a female pelvis. One is willing to go to NYU and see how they have done their Peritoneal cap. However, not what I want. A doctor who recently came to the University system may be more receptive to the idea. She will talk with them more.

Things in my favor though, I have researched this thoroughly. I have noted many videos of the procedure on MRKH women. Noted how those with no vaginal introitus would be just like starting with a male at birth patient from the outside perspective. Noted how a MRKH girls rectal-ureathral pouch is identical to a males rectal-vesical pouch as shown in literature review studies. Then my pelvis is female in shape and depth due to my PAIS. Perhaps this will all help with getting the urologist to want to do the procedure. Once they decide they can do it they will see how it can be done to any normal masculine pelvis also.

Waiting to see what happens. In the meantime, they will be going through the process of submitting to my insurance to get things lined up.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Anna994 on April 29, 2019, 06:57:12 pm
This is very good to know. Thank you for posting this. I am having a peritoneal graft done as a revision as well. My surgery is scheduled for next March with Dr. Bluebond-Langner at NYU.

How long ago did you have your original vaginoplasty?  Mine was in August of 2017. I had quite a few complications leading to dyspaneuria and stenosis. Pelvic floor physical therapy has helped some. I only dilate about once a week now, but I haven't lost any further size to my vaginal canal.

I hope you continue to post your results.

With kindness,

Terri

Hi Terri!

My surgery was October 3rd, my revision 29'th of November, we're waiting 6-9 months until I have intercourse, that's when I intend to update on my results, I've made a separate topic about my surgery as to not crowd Josie's topic, I hope she won't mind!

Glad to hear you had an awesome experience with Dr. Gallagher!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on April 29, 2019, 08:14:10 pm
Hi Terri!

My surgery was October 3rd, my revision 29'th of November, we're waiting 6-9 months until I have intercourse, that's when I intend to update on my results, I've made a separate topic about my surgery as to not crowd Josie's topic, I hope she won't mind!

Glad to hear you had an awesome experience with Dr. Gallagher!


I don't mind at all. I'm hoping all my research helps Dr. Gallagher to find a urologist who will perform the laparoscopic part so I can move forward.

Terri I hope everything works out for you too!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on May 09, 2019, 09:41:48 am
I got a follow-up from Dr. Gallagher's patient coordinator today. She is meeting with the heads of the University hospital urology department later this month to discuss moving ahead with the Davydov style procedure!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Anna994 on May 10, 2019, 06:47:27 am
Fantastic news! Good luck, I watched some of her videos on YouTube she truly seems lovely.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on June 12, 2019, 01:56:08 pm
I got a call out of the blue today to schedule an initial appointment with a urologist at IU Health! I had heard nothing back from Dr. Gallagher's office for some time so this was a surprise. I have an appointment to see him in a couple of weeks from now.
I am suddenly excited!  :o ;D

Thus urologist would be the doctor doing the laproscopic portion of the Peritoneal vaginoplasty.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on June 26, 2019, 04:57:01 pm
I met with the urologist today at IU. He is interested. He is going to go through the studies I gathered and watch some of the videos online of the Davydov procedure. He said what he saw should be no problem as he works in that area all the time although primarily doing prostate removal type surgery. However he said some of what he saw being done to prepare for the Davydov is also what he does when robotically performing prostate surgery. It was another real good talk with a doctor truely interested in doing this procedure.

I believe this doctor is the current urology department chairman there at IU Health.
Title: Re: Now the waiting..............
Post by: josie76 on July 10, 2019, 08:14:53 am
I have good news! The urologist will do the internal part. Now I am waiting on getting insurance approval for both surgeons and getting it scheduled between them.

I think this will make me the first trans-woman (not including CAIS) to get a no-penial inversion PPV / Davydov procedure in the US. This took a lot of research on my part gathering studies and video resources. Just by chance I commented on the video Dr. Gallagher had posted to youtube discussing the concept of peritoneal vaginoplasty. She commented back which is how I got started looking into it with her.

One of the issues Dr. Gallagher had was several urologists who said it wasn't possible to do and less likely with a narrow masculine pelvis. Thankfully she was as determined as I to look into it. Dr. Gallagher met with the university urology chair who agreed to talk to me. I gave him all of my research links and discussed it with him. The day I was there he pulled up a couple of the videos on the computer in the exam room. As he watched them he was describing what he saw being done. To him, he said this seemed so much simpler than what one of the other methods that have been published for revisions described. As he said, what the doctors in the video were doing is exactly how he starts a prostate removal. He even commented about how their laprascopic instruments were shaky. He said its not their fault. They are using the older manual laprascopic tools in the video and thats what it looks like. Because the older instruments are like 2 feet long and the surgeon holds them at the back to work with them. He uses robotic tools. He said its like having his hands right in there.


So while I am going to be the "guinea pig" here, I know that I will have the best working inside of me with the most modern surgical equipment. That and not having to travel around the globe for this surgery is such a relief.


Now waiting to hear from the patient coordinator for insurance and scheduling. …….. :icon_walk:...... waiting....:icon_eek:.....waiting...... :icon_blink:......waiting...... :icon_nervious:...….waiting...... :icon_chick:




https://drive.google.com/file/d/1Z-eFIlpsIgC92Y02iug9YrGnK1LBuBbq/view?usp=sharing (https://drive.google.com/file/d/1Z-eFIlpsIgC92Y02iug9YrGnK1LBuBbq/view?usp=sharing)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: TaylorLeigh on July 10, 2019, 02:55:03 pm
Josie -

That is great news! I had signed up for a consult with Dr. Gallagher based on your report that she was willing to consider performing this procedure. Thank you for all of your efforts thus far! Please keep the updates coming :)

- Taylor
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maybebaby56 on July 10, 2019, 03:47:55 pm
Hi Josie,

Not sure if it's exactly the same procedure you're considering, but Haley Anthony underwent a peritoneal pull-through vaginoplasty in 2017 with Dr. Jess Ting (https://www.wired.com/story/a-patient-gets-the-new-transgender-surgery-she-helped-invent/)  Dr. Ting works with Dr. Marci Bowers.

Dr. Bluebond-Langner and Dr. Zhao, the surgeons I'm going to for a revision, do that procedure as well.

But in any case, congratulations on getting your ducks in a row!  I'm sure you're excited.

~Terri
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on July 10, 2019, 05:07:55 pm
Hi Josie,

That is absolutely fantastic news. I'd say keep us informed...but I'm pretty sure you're going to be doing that anyway. All that studying and research really paid off for you. Congrats!!

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 10, 2019, 05:42:59 pm
Hi Josie,

Not sure if it's exactly the same procedure you're considering, but Haley Anthony underwent a peritoneal pull-through vaginoplasty in 2017 with Dr. Jess Ting (https://www.wired.com/story/a-patient-gets-the-new-transgender-surgery-she-helped-invent/)  Dr. Ting works with Dr. Marci Bowers.

Dr. Bluebond-Langner and Dr. Zhao, the surgeons I'm going to for a revision, do that procedure as well.

But in any case, congratulations on getting your ducks in a row!  I'm sure you're excited.

~Terri

Hi Terri,
So in what I've read and what Dr. Koch the urologist told me I can say this.
Dr. Zhao describes a Peritoneal flap but it doesn't exactly match a Davydov. What he does works for revision but I don't know if it would work as a first step. That's based on the paper Dr. Koch had written by Dr. Zhao but it only had a few crude sketches on it, not good diagrams.

Dr. Ting quoted the Davydov as the Inspiration but did not do a Davydov. His technic removes the portion of the Peritoneal abdominal wall lining that drops through with the testes when they move forward through the abdomen wall. Dr. Ting then grafted this tissue on the inverted penile skin that had been skived of the outer layer.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AshleyPixune on July 11, 2019, 06:37:29 pm
I am so genuinely excited about your experience and I am just so humbled to read about your journey with this procedure.  I have just begun my research into the various surgeries and this already sounds so fascinating, I'll be sure to keep an eye on it.

Thank you so much for being a US trans pioneer!
~Ashlynn
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: HelloKitty on July 13, 2019, 08:23:41 pm
Do you think canadian can have this procedure in your country ?

Does anyone know if Dr. Miroslav Djordjevic (Belgrade, Serbia) does this procedure ?

Thanks
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Tamara Tilly on July 14, 2019, 04:34:15 am
Josie, you really are an inspiration. I'm watching this thread and your progress with love and interest. I really like what I've seen of Dr Gallagher and if this works then I can see myself coming over for it.

You've posted on this thread: https://www.susans.org/forums/index.php/topic,243884.0.html so I'm wondering if Dr Houtmeyers' technique is the same as the one proposed for yours? I personally don't want intestines incorporated into my surgery.

I had a bilateral orchidectomy some time ago, which was done through the scrotum with a single cut. I'm hoping that this won't affect my situation but from what I've read of the technique proposed for you, it shouldn't because the lining inside the scrotum is not used for the pull through?

I know you are seeking this under insurance but has anyone mentioned total cost of the procedure?

Massive good luck and please continue to keep us posted :)

xx
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 14, 2019, 06:05:39 am

The one thing about IU Health where Dr. Gallagher works, is that they will not do GCS as self pay. They will do orchiectomy and other procedures that way but not GCS. I'm not sure why. I was very lucky that my spouse got a job working for the State and this insurance has awesome benefits.

It was Anna994 who had a revision done by Dr. Djordjevic which was supposed to be done like this.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 14, 2019, 06:16:07 am
Josie, you really are an inspiration. I'm watching this thread and your progress with love and interest. I really like what I've seen of Dr Gallagher and if this works then I can see myself coming over for it.

You've posted on this thread: https://www.susans.org/forums/index.php/topic,243884.0.html so I'm wondering if Dr Houtmeyers' technique is the same as the one proposed for yours? I personally don't want intestines incorporated into my surgery.

I had a bilateral orchidectomy some time ago, which was done through the scrotum with a single cut. I'm hoping that this won't affect my situation but from what I've read of the technique proposed for you, it shouldn't because the lining inside the scrotum is not used for the pull through?

I know you are seeking this under insurance but has anyone mentioned total cost of the procedure?

Massive good luck and please continue to keep us posted :)

xx

Hi Tamara,
I also had and orchi done, single midline incision. It is no problem for Dr. Gallagher. Seems most doctors in the US say its no problem either.
I have no clue what the total cost would be. IU Health only does full GCS if you have insurance that covers it.

I know PriyaMed in Mumbia costs around $15000 but includes the 3 week stay in their hostile.
For CAIS girls Drs. Milkos and Moore do it for $10,000 plus hospital fees separate. The do not do genital reconstruction and don't seem interested in treating transwomen.

Dr. Whitehead said he has done the procedure before when he worked as a surgeon in a hospital for a cis-gender MRKH girl. He now owns the old Reed Center and does scrotal graft on penial inversion type. He does not own his own set of laprascopic tools.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: norabelrose on July 17, 2019, 11:02:09 am
Hi all,

I have also been talking with Dr. Gallagher and Dr. Koch about getting a peritoneal vaginoplasty done, and I just got it scheduled for the 29th (I know, short notice!). Dr. Koch mentioned that there was one other girl who he had talked to about the procedure- I guess that must have been you, josie76! :) I'll keep you all up to date on how my results turn out.

Best,
Nora
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 17, 2019, 05:06:01 pm
OMG! Congrats. I do feel a bit jealous though. It's ok.

I am assuming my insurance has not yet approved both doctors in the surgery. God you mean the 29th of July? Honestly I'm a bit depressed by that. I'm going to try to reach out to Emma and find out what is happening.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 18, 2019, 08:20:42 am
Hi all,

I have also been talking with Dr. Gallagher and Dr. Koch about getting a peritoneal vaginoplasty done, and I just got it scheduled for the 29th (I know, short notice!). Dr. Koch mentioned that there was one other girl who he had talked to about the procedure- I guess that must have been you, josie76! :) I'll keep you all up to date on how my results turn out.

Best,
Nora


Please do update us with how it goes. I am truly excited for you. I know I have been looking at this procedure for a long while and just happened to find Dr. Gallagher's YouTube. She was really open to the concept and just needed a laprascopic surgeon on board. Dr. Koch is great also. I have complete faith in his abilities in that small region of the body.

The patient coordinator Emma did email me back last night. Both offices are working on getting my insurance approval through so I guess thats my holdup. Still exciting that you get to do it sooooo soon!

Josie


BTW here is some of the info I gave to Dr. Koch. It took less than a week for him to email and say he could do it.
https://drive.google.com/file/d/1Z-eFIlpsIgC92Y02iug9YrGnK1LBuBbq/view?usp=sharing (https://drive.google.com/file/d/1Z-eFIlpsIgC92Y02iug9YrGnK1LBuBbq/view?usp=sharing)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on July 29, 2019, 08:30:33 am
Well Nora is getting her surgery today! I hope to hear how she is doing in the next couple of days.

 :icon_birthday: CONGRATS Nora! :eusa_dance:



My own dysphoria is through the roof these days. I can't wait to hear when I can get a scheduled date.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on July 29, 2019, 02:07:35 pm
Good luck Dora.  I wish the best results and a speedy and hopefully painless recovery.  We can dream can't we?  I am very interested in following you'rs and Josie's paths to happiness.  Thanks for sharing Josie.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: norabelrose on July 30, 2019, 11:50:59 am
The surgery went well, with no complications! My pain is quite low, around a 1 or a 2. They were able to use at least 5 inches of peritoneal tissue to create the vaginal canal.

So glad to have that gross, out-of-place growth between my legs removed :)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Northern Star Girl on July 30, 2019, 12:00:35 pm
The surgery went well, with no complications! My pain is quite low, around a 1 or a 2. They were able to use at least 5 inches of peritoneal tissue to create the vaginal canal.

So glad to have that gross, out-of-place growth between my legs removed :)
@norabelrose
Dear Norabelrose:
    Please know that I am not ignoring or trying to sidetrack your post... , but  you need to be Officially Welcomed and given important rules and information about the Susan's Place Forums.
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    I also want to warmly WELCOME you to Susan's Place
You will find this a safe and friendly place to share with others and to read about others similar trials, tribulations, and successes.

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Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Northern Star Girl on July 30, 2019, 12:01:32 pm
@norabelrose 
OH, and another thing Norabelrose:
Please plan to write a post and briefly introduce yourself in the Introductions Forum (https://www.susans.org/forums/index.php/board,8.0.html) so that other members will be aware of your arrival... therefore you will be able to share your thoughts with more members here.
     
Thank you again for joining Susan's Place and being involved in the Forums here.

Best wishes to you,
Danielle

NOTE: Now after all of this Greeting Stuff I will you and everyone have this thread back so that the exchange of conversation can continue.
Other members here will certainly be along to give you their comments and replies
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Tamara Tilly on July 31, 2019, 12:31:14 pm
The surgery went well, with no complications! My pain is quite low, around a 1 or a 2. They were able to use at least 5 inches of peritoneal tissue to create the vaginal canal.

So glad to have that gross, out-of-place growth between my legs removed :)

Wow what fantastic news Nora. That's just awesome. I think a lot of us watching with great interest to see how this went so when you feel up to lots of extra details would be fabulous. In the meantime, heal well!

Oh and welcome to the forum!

xx
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on August 10, 2019, 12:04:37 am
Wow, what a hugely important topic this is.  It would not surprise me that within the next three to five years something like this is the new standard surgery for MTF GRS.

Thank You so much for sharing!!!

Take care,
Jane Shannon
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Dorit on August 10, 2019, 04:30:47 am
I am following this thread with great interest.  Thank you all for sharing your experiences.  For complex reasons I had a partial vaginoplasty last December with only a 2cm. vaginal depth.  The peritoneal technique would be the way to add a true vaginal canal if I so decided in the future.  The other technique, a sigmoid colon vaginal canal, is much more complicated and invasive.   So encouraging for me!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 10, 2019, 06:32:33 am
I have a scheduled (preliminary) surgery date!!!!  :D

Mid September

The patient coordinator emailed me yesterday with it. She did say we can plan for it but a few of the other doctors need to reschedule some patients for that day. IU Health is a teaching medical school hospital so I kind of expected it. I know Dr. Gallagher had posted that the day of Nora's surgery they had an OR full of other staff and interns.

Dr. Gallagher will be doing my outside portion and Dr. Koch (urology chair) will be doing the robotic laparoscopic portion. I know when I met with Dr. Koch back on June he said something about wondering if the pediatric gynecology surgeons had ever done or seen this for MRKH patients. I'm sure they will have others from the urology department in there also so they can perform this part in the future.

Nora messaged me after hers that Dr. Gallagher said that it was really simple and that she wondered why all GCS surgeons weren't already doing it this way.

I'm ecstatic and anxiously waiting!  :icon_biggrin: :icon_blink: :icon_joy: :icon_nervious: :icon_walk: :icon_rolleyes2:
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Tamara Tilly on August 11, 2019, 08:53:56 am
This is potentially phenomenal. Josie, I wish you all the very very best.

I have a lot of respect for Dr Gallagher and am thrilled and excited at her reported comment from Nora that 'it was really simple and that she wondered why all GCS surgeons weren't already doing it this way'

 
On so many levels this type of GCS surgery could be a breakthrough.

Nora / Josie, please keep us posted on after-surgery care. For example, how much dilation is required. How you find the apparent self-lubrication.

Bravo!

xx
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 17, 2019, 06:21:01 am
My date is officially set! In 3-1/2 weeks I will go under the knife! I have to say this is the most I have looked forward to a surgery ever! Right now it still seems vague and unreal of a concept. This is the one step I thought I might never get to.


Nora messaged me. Since she is not on here hardly at all, I hope she doesn't mind my relaying a bit of what we talked about. In general she has not had trouble dialating. Also she noted that the vaginal discharge itself seems to help prevent the blood from forming hard clots. I guess that is what would be called granulation. So overall the procedure is working well in every aspect. She went for a 10-15 minute walk around her house last week so she must be feeling pretty good.

I can't wait to find out for myself. And to wake up and not have the "thing" there anymore. The idea of being "normal" was something I convinced myself was just not possible in my life way back around when puberty hot so it's hard for me to see that it is really happening. I'm sure it will become more real as the date approaches.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Diffidence on August 17, 2019, 09:58:12 am
That’s awesome! I’m really looking forward to hearing from both you and Nora about the results. I’m currently just on the waiting list for a consultation. In your first post you mentioned finally getting insurance to cover this, so I was wondering if that’s when you originally called or filled out their form. On their site it says wait times for consultations are about 5 months and that she’s typically booked out about 2-3 months for surgery, so does around 8 months or so seem fairly accurate?


Sent from my iPhone using Tapatalk
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 17, 2019, 06:50:32 pm
I sent all of my letters and insurance info around the end of March or so. I met Dr. Gallagher right at the end of April or so. In mid-May I got an email that said Dr. Gallagher was going to meet with the heads of the urology dept at the end of May. I enquired again after June began. I didn't get a reply but a few days later I got a call to schedule a consult with Dr. Koch. I saw Dr. Koch at the end of June. Funny thing was Dr. Koch came into the room and started out by saying he wasn't really sure what was going on. So while Dr. Gallagher had discussed the issue of using peritoneal tissue, Dr. Koch did not have a firm idea of what I and Dr. Gallagher had discussed. Mainly because while she was interested in the method none of the previous urologists she had asked said it was possible. Also there was a bit of confusion between the doctors as to the name of the method. I guess Dr. G spelled it a bit different and Dr. K thought she wrote something completely different. So Dr. K and I talked a bit and I emailed him my research links from my phone. He brought it up on the PC there and in just a few minutes he said it looked doable. Then he watched a few of the videos of doctors doing the procedure on MRKH women. He said it looks like something that would be doable but he wanted to do some more research. A week later he emailed both me and Dr. G that he would do the procedure. I guess right after that Nora saw him for a consult. Anyway I kind of think that they held off scheduling me until they had some details on results from Nora's surgery since it seems like they put me in about 6 weeks later.

I don't know what the regular surgery wait would be.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: zirconia on August 18, 2019, 03:58:50 am
Yea! Congratulations and good luck, Josie! ٩( ᐛ )و
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 21, 2019, 06:39:07 am
Well 3 weeks left! I'm excited and anxiously waiting!
 ;) ;D
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on August 21, 2019, 08:15:33 am
Hi Josie,

I'm so happy for you!! I can't even imagine how excited you must. I'd probably be shaking every time I thought about it if it were me in your position.

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 22, 2019, 06:05:40 am
I've been emailing with the Dr. Right now based on what I want to see, it sounds like she will do a version of a "Chonburi flap". This is what Dr. Suporn created. It does not invert the penial skin but primarily uses that skin to form the vestibule and labia minora. Dr. suporn relies on the pupace which I don't have since I am circumcised. However it doesn't seem to be required to use a similar technic. Since the vaginal canal will be peritoneal tissue, there is no worries about needing extra penial skin length.

I'll find out soon enough
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on August 22, 2019, 07:55:27 am
Hi Josie,

Have you ever thought about becoming a doctor or a medical researcher (if you're not already)? You know more about these surgeries than I think even the surgeons know. In fact didn't you, in essence, teach your surgeons how to do the operations they're going to perform on you? Maybe they'll name a new surgical procedure after you.  ;)

I find that brilliant! I hope you'll share all your tips, tricks, and techniques with me when it's time for my surgery, so I can have as good a results as you're going to have.  :)

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 22, 2019, 04:47:00 pm
Well I knew it was a possibility because of PriyaMed in India getting the doctors at that university hospital to do it. Then just by chance Dr. Gallagher had put a video about the concept on YouTube. I commented and she replied back that she was wanting to offer something like it in Indianapolis. I didn't teach anybody but I did the research to provide the right info to the doctors. Thankfully Dr. Gallagher was really in support of the concept and Dr. Koch is super experienced in laparoscopic peritoneal surgery and once he saw some of the videos I think he knew it was doable. Its nice that IU is a university and has doctors willing to look at new ideas and put together a plan to use them.  :D
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: SnoBrittany on August 22, 2019, 08:05:35 pm
Wow Josie you are SO inspiring and I wish you the best of luck and a swift recovery!   I will be watching to see how you do and hope to learn more about the procedure you're having.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on August 22, 2019, 08:23:01 pm
Thinking of you Josie as these days tick down.
Following your story.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on August 24, 2019, 06:50:23 pm
Josie,
I understand with PPV that the formation of the the Vulva is very similar to the techniques used in penile inversion surgery, and the difference really starts about 1.5cm into the vagina.  Are you doing something different than this?
Thanks,
Jane Shannon
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 24, 2019, 08:55:34 pm
Yes I don't want to have the standard penial inversion for my external parts. What Dr. Gallagher has suggested is something like what Dr. Suporn calls his Chonburi flap method. This is a non inversion.

From Dr. Suporn's description, the dorsal side of the penial skin is left connected at the base and layer in as the floor of the vestibule. Dr. Suporn makes a neoclitoris complete with frenulum and labia minora connected to the frenulum. From what I have found, he stops short of describing how he builds the vagina except he says he uses penial and scrotal skin. With a Peritoneal pull through the most that might be needed is skin at the vaginal introitus. I thought perhaps the end of penial tube after being degloved could form this if it is needed. I will know more when I see Dr. Gallagher again on my surgery day.  Anyway, the penial skin is thin and has no subcutaneous fat so it is ideal to create the labia minora, and clitoral hood out of.
With the Davydov method there is no reason to pull the penial skin down and invert it. Doing so has so many downsides that simply aren't needed to be dealt with.

2-1/2 weeks out now.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 28, 2019, 06:44:19 am
Well I'm 2 weeks out today. Anxiously waiting the days away. I stopped my hormones a few days ago. I have emailed the patient coordinator twice asking if they had the specifics yet. She told me the date was set but I have not seen a letter with the time to arrive or anything. This is just making me more anxious. I'm sure it will be fine but lack of information is troubling to me personally. The patient coordinator in Dr. Gallagher's office has to handle all of this by herself. This leads to lapses in communication. IU Health really needs to hire her help for her department. Other doctor's offices there have multiple people handling the insurance and scheduling. As busy as the gender affirmation department has become they definitely need more help. Dr. Gallagher herself is doing many surgeries per week bot mtf and ftm.

I know all this but still, nerves.  ??? ::) :P
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maybebaby56 on August 29, 2019, 06:04:31 pm
Well I'm 2 weeks out today. Anxiously waiting the days away. I stopped my hormones a few days ago. I have emailed the patient coordinator twice asking if they had the specifics yet. She told me the date was set but I have not seen a letter with the time to arrive or anything. This is just making me more anxious. I'm sure it will be fine but lack of information is troubling to me personally. The patient coordinator in Dr. Gallagher's office has to handle all of this by herself. This leads to lapses in communication. IU Health really needs to hire her help for her department. Other doctor's offices there have multiple people handling the insurance and scheduling. As busy as the gender affirmation department has become they definitely need more help. Dr. Gallagher herself is doing many surgeries per week bot mtf and ftm.

I know all this but still, nerves.  ??? ::) :P

Hi Josie,

I understand how you feel. I waited for months for my date to come around, and the last couple of weeks it was almost impossible to think about anything else, even though I understood I had to keep engaged with work and my daily existence. It was torture!

I send you my best wishes for your surgery and hope you will continue to post afterwards. I have a peritoneal graft revision surgery scheduled with Dr. Bluebond-Langner in March, and I want to hear as much about your recovery as you are willing to share!

With kindness,

Terri
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: ALC_132 on September 04, 2019, 03:13:50 am
Hi Josie,

The whole experience sounds so incredibly exciting! I hope your recovery goes well.

I know you're probably busy prepping for surgery but I am looking at getting surgery in Australia at the moment and am trying to arm myself with as much information to see if I can chat to the surgeons about it.

Just hoping to clarify, the vulva is made as per any SRS procedure but the whole vaginal canal is made from peritoneal tissue that is sourced whilst being under, removing the need to preform incisions around the bellybutton?

Do you have anymore info that may be useful in chatting to my surgeon about this?


I appreciate all the help you can be!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 04, 2019, 06:39:36 pm
Hi Josie,

The whole experience sounds so incredibly exciting! I hope your recovery goes well.

I know you're probably busy prepping for surgery but I am looking at getting surgery in Australia at the moment and am trying to arm myself with as much information to see if I can chat to the surgeons about it.

Just hoping to clarify, the vulva is made as per any SRS procedure but the whole vaginal canal is made from peritoneal tissue that is sourced whilst being under, removing the need to preform incisions around the bellybutton?

Do you have anymore info that may be useful in chatting to my surgeon about this?


I appreciate all the help you can be!


OK so,
The vaginal canal is made from peritoneal lining pulled down forming a tube and closed at the top end. "Davydov" method.

The vulva in my case will be made a bit different than usual. Dr. Gallagher said she can do a version of the "Chonburi flap" method that was created by Dr. Suporn. The dorsal side (top) of the penial skin is laid down to form the inner labia and vestibule. The big difference is that there is no need to pull the abdominal skin down. The penial skin is used with the back of the dorsal side left connected but the bottom side incised open along the length.

In regular penial inversion, the penial skin is kept as a tube and pulled down until the base of the penile skin can be positioned where the vaginal opening should be. This requires pulling the abdominal skin down and requires removal of significant amounts of skin on either side to flatten back out the whole area. This also means there is a lot more tension on the skin and stitches at the bottom of the area.

No I'm really not doing anything yet. In fact I'm still waiting for the information packet to show up so I know when to arrive at the hospital.


Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 10, 2019, 07:17:39 am
Well I go into surgery tommorow morning! Kind of starting to feel real.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 10, 2019, 07:38:39 am
Well I go into surgery tommorow morning! Kind of starting to feel real.
Excited for you Josie.
Hope you received the instructions packet you were waiting for!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: zirconia on September 10, 2019, 08:26:14 am
You must be excited! I wish you the best (and am jealous...)
Rest well, if you can...
Good luck...
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 10, 2019, 09:37:24 am
Excited for you Josie.
Hope you received the instructions packet you were waiting for!

I did get it by email but never saw the one that was supposed to be mailed to me. I had to email both doctors patient coordinators before Dr. Gallagher's office emailed me a copy back.
Dr. Gallagher's office only has one lady doing everything with insurance and scheduling. As aggrivating as it is trying to get communication with the office, I don't blame her. The gender clinic is so busy that they need to hire her help. The urologist office has an entire staff to do the same job.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Dorit on September 10, 2019, 11:31:29 am
Josie dear, this is exciting!   Thank you for being a pioneer in the community.   Before you know, it will be over and you will find yourself in the recovery room so grateful that you were able to do this.  Love you!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on September 10, 2019, 02:07:11 pm
Good luck and Godspeed.  I can't wait to read your first post op posts.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 10, 2019, 03:41:56 pm
Hi Josie,

I had your surgery date in my calendar so I wouldn't forget to send you a supportive message. It seems like I"m kind of behind the other girls though. But that's okay...it just lets you know that we're all thinking about you.

Good luck with your surgery!! I look forward to reading your first post-op reports. I imagine it will be a day or two though.  :)

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: mm on September 10, 2019, 11:39:28 pm
Good luck for you and we will be waiting for a report on how the girl is doing.  You will do very well.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on September 10, 2019, 11:57:23 pm
All the best Josie!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 12, 2019, 09:55:03 am
Everything went fine. They said they were able to do everything we had talked about. Pain is minimal as lo g as I am just lying down. The additional incisions from the laparoscopic robot make it painful to contract my stomach muscles. I am supposed to stay in the hospital until Saturday
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Dorit on September 12, 2019, 11:08:34 am
Congratulations Josie!  Rest well, be kind to yourself!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 12, 2019, 12:09:17 pm
That's good news Josie.  Congratulations.
Best wishes as you recover
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 12, 2019, 02:05:42 pm
Everything went fine. They said they were able to do everything we had talked about. Pain is minimal as lo g as I am just lying down. The additional incisions from the laparoscopic robot make it painful to contract my stomach muscles. I am supposed to stay in the hospital until Saturday

Hey Josie,

That's fantastic news!! Just take it easy and do whatever the doctors tell you to do. I had stomach surgery once and was told not to flex my stomach muscles. That's easier said than done though. You use your stomach muscles for nearly everything you do...even blowing your nose. Just know that it will get better soon and that it will all be worth it in the end.

I hope you're able to get some sleep. We'll all be thinking about you and pulling for your quick recovery.  :)

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on September 12, 2019, 02:57:22 pm
Welcome back!!  I am happy for that your pain so far is minimal.  I have had 4 laparoscopic surgeries.  It takes 5 - 7 days for the pain at the incision point s to basically go away.  Good luck with the rest.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: zirconia on September 12, 2019, 03:53:22 pm
Everything went fine.

Yay!♡
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 13, 2019, 08:01:08 am
They are supposed to get me up out of bed later. They said if I am up to walking then I should be able to go home tomorrow. I had a fever last night but thankfully that broke. My temp is back to normal as is my appitite. I'm waiting on breakfast.
Dr Gallagher said she was able to do everything we discussed. She is amazing and willing to review my Cruse sketches of sensate areas. Dr. Koch was able to get "a lot of depth" in my Peritoneal tube vaginal canal. I guess I will know more about that next week when the packing gets removed.

All in all I'm glad I did this in a hospital setting.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 13, 2019, 08:15:51 am
Wow, Josie.  I read at least 6 positive things in your one paragraph.
I could only hope to be that good, journaling from a hospital bed.

Healing vibes.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 13, 2019, 10:31:55 am
The physical therapist came and got me sitting up. Had to wait for the BP machine to finish before standing. Then wait for the BP machine again. So they just unhooked me from an IV with a BP lowering drug a few hours before. According to the PT most surgical patients are only on this drug for a day. I was one it for 3. My BP was plenty low but I was not dizzy. We walked half way around the hall with a walker. Then did a round and a half unassisted. She also had me go up a few stairs and back down.

Now I'm in a recliner. I'm not supposed to move unless there is someone to help. They have me in a gate belt and just basic monitors now. No more IV.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: steph2.0 on September 13, 2019, 11:47:06 am
Josie! I just saw this thread for the first time. I had standard penile inversion with Marci Bowers on the 11th and they removed the dressings this morning. It’s beautiful! I had originally met with Dr. Ting’s staff at Mt. Sinai about the peritoneal procedure but all he did was use the lining of the scrotum for additional graft material. I almost went to Gallagher for PI but ended up with Bowers and don’t regret it, though I’m watching your progress with interest.

All the best with your healing, sister!


- Stephanie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 13, 2019, 01:06:10 pm
Hey Josie,

I'm super happy to hear everything is going well. I bet you're looking forward to going home. Will you still have a catheter when you get released, or do they take that out beforehand?

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 13, 2019, 01:40:39 pm
I will have a cathitor and packing untill next week at my follow-up appointment. Then they will go over dialation.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 13, 2019, 01:42:42 pm
That will probably make your life easier in the long run. I can't imagine having to learn how to pee at this stage. How is your family doing with everything? Is your wife still there with you?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 14, 2019, 07:08:50 am
They said I should be going home today!
Two of Dr. Gallagher's residents took the main bandage off. The packing stays until my follow-up appointment in the office.
So I'm bruised and swollen but results are very good.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Stevi on September 14, 2019, 07:07:47 pm
Hi Everyone,

Congratulations, Josie.  Sounds like you made good choice with Dr. Gallagher.

I have a consult scheduled for the 27th with Dr. Gallagher.  One of the reasons I am considering her is that she does not require prior hair removal.  I believe she cauterizes the follicles during the procedures.   I know there are other surgeons that have backed off of the prior hair removal requirement, as well.  Question-  Is that satisfactory?  Anyone out there sorry they did not clear the hair beforehand?

Thanks,
Stevi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: steph2.0 on September 14, 2019, 08:15:42 pm
Hi Everyone,

Congratulations, Josie.  Sounds like you made good choice with Dr. Gallagher.

I have a consult scheduled for the 27th with Dr. Gallagher.  One of the reasons I am considering her is that she does not require prior hair removal.  I believe she cauterizes the follicles during the procedures.   I know there are other surgeons that have backed off of the prior hair removal requirement, as well.  Question-  Is that satisfactory?  Anyone out there sorry they did not clear the hair beforehand?

Thanks,
Stevi

Even Marci Bowers no longer requires it. Instead of scraping she has them excised just like they would be for a hair transplant. Of course, you wouldn’t want them on your head...


- Stephanie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 15, 2019, 01:19:49 am
I'm at home now. It was a 4 hour car ride on just a doughnut cusion. I did take oxi for the ride home but oh how I dislike the comedown from that stuff. Back on just Tylenol. Took a shower which was wonderful! While I am sore I can sleep on both of my sides. My lower region is very swollen so I def keep activity to a minimum. Still sleepy tired.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 15, 2019, 01:24:55 am
I'm at home now. It was a 4 hour car ride on just a doughnut cusion. I did take oxi for the ride home but oh how I dislike the comedown from that stuff. Back on just Tylenol. Took a shower which was wonderful! While I am sore I can sleep on both of my sides. My lower region is very swollen so I def keep activity to a minimum. Still sleepy tired.

Hi Josie,

I'm glad to hear that you're home and doing well. I'm also glad to hear that it's possible to sleep on your side. That's something I've been dreading about GCS. I was afraid I'd have to sleep flat on my back for weeks at a time. Were you able to do that the day after surgery, or did you have to stay on your back until now?

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 15, 2019, 01:30:04 am
Even Marci Bowers no longer requires it. Instead of scraping she has them excised just like they would be for a hair transplant. Of course, you wouldn’t want them on your head...
Stephanie

Hey Steph,

Is that guaranteed to work? I'd hate for them to do some unproven method on me, then I'd end up with hair all over the inside of my kitten. Meow meow.  :laugh:

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 15, 2019, 06:23:10 am
Hi Josie,

I'm glad to hear that you're home and doing well. I'm also glad to hear that it's possible to sleep on your side. That's something I've been dreading about GCS. I was afraid I'd have to sleep flat on my back for weeks at a time. Were you able to do that the day after surgery, or did you have to stay on your back until now?

xoxo
Lexxi

Lexxi, I did not sleep on my side at first. In the hospital bed I slept on my back but with the bed sat up and that automatic air mattress adjusting for my body it was super comfy. By Friday night I was unhooked from some of the IV drips and I found lying on my side was possible with the bed set near flat.
Also remember I had 5 abdominal incisions from the Davinci robot for the laparoscopic portion. A normal penile inversion would not have all of those incisions and abdominal pressure to deal with. I was also doing some walking on Friday with the physical therapist.
Now at home I slept on my side all night.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 17, 2019, 07:23:56 pm
I'm back in Indianapolis tonight. My 1 week post surgical follow-up is first then ng tommorow. I will finally get this cathitor removed and the vaginal packing gauze strip.
The packing has been a hassle keeping it from working loose especially when I need to use the toilet. In the hospital the main bandage held the packing tight. They removed that bandage before discharging me. I've been using adult diapers type pads and mesh post partum panties all this week now. I'm ready to be done with all of that and down to just using pads in my regular underwear.
The 5 hour car ride back to Indi was not fun. The packing puts pressure on the cathitor in my bladder and urethra. It's just uncomfortable at first but after hours it hurts. Using a doughnut pillow helps as does reclining back but it is definitely one of my worst parts of the experience.
Otherwise pain is minimal. Tylenol only is needed for pain.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 18, 2019, 10:19:19 am
The cathitor and packing is gone!
The nurse gave me instructions on dialating. I practiced with her instruction. I was able to use the third size dialator with full depth today. Seems the urologist was able to get nearly 7" of depth.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Janna on September 18, 2019, 05:13:30 pm
OMG I'm so jelly!

I've been wanting this type of surgery since I learned about it.  Your info and experience has been invaluable and it's amazing you managed to single-handedly convince a doctor to try out these new methods.  You're so brave, and so intelligent.

I just finished reading this whole thread.  Early on, you said docs were unsure about doing this surgery with a male pelvis but were more willing to try with your female-like pelvis.  Any update on that?  Do you know if Nora had a male-style pelvis?

I've been really depressed the last couple days wondering how to get this surgery myself.  I moved to Kaiser last Jan because they have such a good transgender program in my area, but they don't offer this surgery.  Back in June my rep said they were looking into offering this, and now I asked for an update and he acts like he never even said they were looking into it.  Nor will they pay for anyone outside the Kaiser system to do this surgery.

So my only options seem to be priyaMED in Mumbai (not Mumbia as some keep spelling it) or I need to switch insurance soon and lose my FFS surgery date with Kaiser and fight new insurance to cover an experimental procedure (I'm actually surprised your insurance covered you - I wonder if they really understood what they were doing).  Or wait for FFS early next year and then be unable to change insurance till the end of next year.  All these options suck in different ways.  =(

Anyway, thanks for being a pioneer, for all your hard work, and especially for your amazing communication and updates.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on September 19, 2019, 01:26:15 am
Hi Josie,

That is absolutely fantastic news!! I'm so glad you're progressing so quickly. Well it's quickly in my book at least. You might think differently.  :laugh:

I read where someone said you were able to have your surgery because you had a more female pelvis. I probably read that earlier in the thread, but forgot about it. Anyway, will they do the same kind of surgery you had if a person has a more male pelvis? I have no idea what my pelvis looks like, so it's kind of concerning since I want the exact same surgery you had.

Once again I'm glad you seem to be getting along so well. Just keep doing what the doctors say and you'll be just fine.

I'll talk to ya later,

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on September 19, 2019, 01:18:04 pm
Wonderful news.  I hope your recovery keeps going well.

Allie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 19, 2019, 06:09:21 pm
OMG I'm so jelly!

I've been wanting this type of surgery since I learned about it.  Your info and experience has been invaluable and it's amazing you managed to single-handedly convince a doctor to try out these new methods.  You're so brave, and so intelligent.

I just finished reading this whole thread.  Early on, you said docs were unsure about doing this surgery with a male pelvis but were more willing to try with your female-like pelvis.  Any update on that?  Do you know if Nora had a male-style pelvis?

I've been really depressed the last couple days wondering how to get this surgery myself.  I moved to Kaiser last Jan because they have such a good transgender program in my area, but they don't offer this surgery.  Back in June my rep said they were looking into offering this, and now I asked for an update and he acts like he never even said they were looking into it.  Nor will they pay for anyone outside the Kaiser system to do this surgery.

So my only options seem to be priyaMED in Mumbai (not Mumbia as some keep spelling it) or I need to switch insurance soon and lose my FFS surgery date with Kaiser and fight new insurance to cover an experimental procedure (I'm actually surprised your insurance covered you - I wonder if they really understood what they were doing).  Or wait for FFS early next year and then be unable to change insurance till the end of next year.  All these options suck in different ways.  =(

Anyway, thanks for being a pioneer, for all your hard work, and especially for your amazing communication and updates.

Well thanks but I did not have to convince Dr. Gallagher. She had an interest in a peritoneal vaginoplasty but that area is outside of her common practice. She is specialized in plastics. It was because I found her YouTube video expressing interest in the concept that I contacted her and her office. Timing was just right. She had been asking urologists about it all that spring but most said the procedure could not be done. One said they might look at what was done at NYU but was not ready to fully commit in April when I saw her. I came with a great deal of information and her and I drew sketches on a sheet of paper of my ideas and her, how she has done certain procedures before.
In the next month Dr. Gallagher met with the heads of the University Urology Dept. and asked them for help. Dr. Koch, Urology Chair at IU Health, was willing to look into seeing if there was anything he could help with. He told me he had not come away from that meeting with a very good idea of what Dr. Gallagher was asking for. He had looked at some of the rough presentation material NYU had released but was not certain without seeing a surgery done.
I walk into my consultation with him in June and he immediately said, he did not know exactly what needed to be done. I think Dr. Gallagher's office asked him to just meet with me to discuss it. We talked a while and I was able to email him a series of studies and a list of published study and case study citations. Along with this the links to several videos of doctors across the world doing this for MRKH girls.
After we had talked he started viewing some of the video links. As he watched he described what the surgeon was doing. At the end of one he said he was pretty confident he could help do the procedure. He wanted to look over the rest of the studies and links. By the end of the next week he had emailed me and Dr. Gallagher saying he would assist in making this happen.

I think this is a big bonus of it being a university hospital system. The doctors are always willing to learn and work on new techniques. This surgical technique is a big deal here in North America.

I read where someone said you were able to have your surgery because you had a more female pelvis. I probably read that earlier in the thread, but forgot about it. Anyway, will they do the same kind of surgery you had if a person has a more male pelvis? I have no idea what my pelvis looks like, so it's kind of concerning since I want the exact same surgery you had.
Lexxi

At my first meeting with Dr. Gallagher she said the first urologist she was talking to had concerns that a PPV would not work on a male pelvis because it is narrow and deeper. Turns out this definitely won't stop good doctors.
So if they could not have pulled the peritoneal tissue down far enough safely, Dr. Gallagher can use a portion of penile skin for the outer entrance (introitus).
On the first PPV they did they did need a couple cm of skin. On mine they were able to pull the peritoneal through plenty but as Dr. Gallagher and I discussed, she used a ring of penile skin to form the foundation of the introitus.






So details, I had appearantly unusual sensitive areas and numb areas in what is commonly used for the neoclitoris. I discussed this ahead of time. Dr. Gallagher used a modification of a Chonburi flap for me. No real penile inversion. Not really anyway. No stretching of the skin from the abdomen. She used my frenulum area to form my neoclitoris. She uses part of the extra length of urethra to add mucusoid lining in the floor of the vestibule.

I am so far using the purple dialator of the 4 piece set. I can hold to the first grip notch on the back as far as depth. My peritoneal tissue is producing its own fluid and right now is able to flush any blood from scabbing inside. The only uncomfortable part of dialating is getting past the pelvic floor muscles and a few areas where internal swelling has to be worked around. I only require a small bit of lube on the dialator to get started.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 25, 2019, 06:33:26 pm
Here comes the healing issues.

The stitches around the perenium and my vaginal entrance have fully dissolved. Now it has pulled apart some. I have the white, guess it's collogen tissue. Slightly painful but from what I've read the red granulation tissue comes next. Not ideal or what I had hoped for. When I left the hospital it was all stitched up nice and clean.

Otherwise still have swelling but it's less overall.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 26, 2019, 10:59:18 pm
Is this a setback, or a bad complication ?

Sorry I don't know.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 27, 2019, 12:38:48 pm
Is this a setback, or a bad complication ?

Sorry I don't know.

Right now it seems it just means it will take longer to heal on the outside. I may have to deal with pain when dialating in that spot because what is called granulation tissue is often painful to touch until a new layer of skin grows across it.
I have to wonder that if I had not had dissolvable stitches if I might have been spared this external pain and only had the swelling underneath.

It's not unusual in general with any vaginoplasty to have a wound there. It's where the most movement happens. I think in my case it's just because how quickly my body dissolved those stitches away.

I see the doctor next week. On the plus side, internally dialation is as easy as ever.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 27, 2019, 02:10:39 pm
Glad there is a plus side.
Thx for explaining
Get well soon :)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Janna on September 27, 2019, 02:25:47 pm
Nuuu!  Dehiscence begone!

When I had surgery on my toe, they used non-dissolvable stitches and after removing them, it left a dent that took a long time to disappear.  So despite the extra healing time, maybe dissolvable stitches are more likely to look better when healed?  We can hope.

Thanks again for continuing to post the bad updates along with the good.  I want as much info as possible.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on September 27, 2019, 10:58:16 pm
I hope your healing continues quickly. Thanks for the updates, good and bad, they are important.
thanks,
Jane
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Dorit on September 28, 2019, 01:26:28 am
Sometimes non-dissolvable stitches can have a different problem.  I have been suffering from complications.  I had a gynecological exam eight months post op and the doctor reached in and pulled out a thread from my vaginal introitus!  The surgeon missed one. :(

Josie, thank you so much for keeping us posted!   This is just a bump in the road.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Iztaccihuatl on September 29, 2019, 11:34:45 pm
Josie,

One question: It is my understanding that a peritoneal graft is mucosal by itself, since the peritoneum is a mucus membrane. Therefore a certain amount of discharge can be expected. While it might be a bit early for you to give a solid answer on this, but did you discuss with your doctors whether this could be expected to be similar in amount and / or consistency  compared to discharge from a cis woman's vagina?

Thanks,

HM
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 30, 2019, 10:18:27 am
Josie,

One question: It is my understanding that a peritoneal graft is mucosal by itself, since the peritoneum is a mucus membrane. Therefore a certain amount of discharge can be expected. While it might be a bit early for you to give a solid answer on this, but did you discuss with your doctors whether this could be expected to be similar in amount and / or consistency  compared to discharge from a cis woman's vagina?

Thanks,

HM

Hi
Yes I expect a certain amount of normal mucusoidal discharge within the neovagina. I have read multiple papers describing the fluid that the Peritoneal vagina lining produces in MRKH girls and what PriyaMed had their doctors examine in India. After the peritoneum heals closed at the end, the exposed lining of the vaginal canal will take on an epidural like quality. It will continue to secrete moisture. The studies following this method have shown that the peritoneum will produce a fluid similar even in pH to natal vaginal lining secretions. Also once the inner surface epthilizes it will no longer attempt to self seal closed.

The amount of moisture is not normally enough for full sexual penetration activity so a bit of normal personal lubricant is suggested for sex. However it will remain self moistening. Unlike a natal woman with a cervix and uterus there is no expectation of increased discharge from hormonal cycles. Natal women often experience that increase from their bodies during ovulation.

This is all based on what I have read. What I can say for certain is I have no trouble with dialation except for external and an area of internal swelling still. I do have stitches just inside my vagina where the doctor connected the skin to the peritoneum tissue but they seem to be no bother. My biggest issue is the external healing and how the incision pulled apart. I think that is slowly healing and has been less of an issue compared to last week.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: autumnfaye_xoxo on October 03, 2019, 09:01:11 pm
Josie,
This is amazing and the exact procedure Ive been trying to have. I had already set up consultations with a few doctors but could only find the peritoneal cap penile inversion technique. I set up a consult with Dr. Ting but im really glad to have his surgical procedure cleared up and a definite answer that Dr. Ting does not do a tru Davydov procedure. Won't have to spend a bunch of  money flying all over the country. I already put in a consult inquiry with Dr. Gallagher so hopefully she wont be booked to far out. Did you have any issues with insurance coverage?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 05, 2019, 10:18:33 am
Josie,
This is amazing and the exact procedure Ive been trying to have. I had already set up consultations with a few doctors but could only find the peritoneal cap penile inversion technique. I set up a consult with Dr. Ting but im really glad to have his surgical procedure cleared up and a definite answer that Dr. Ting does not do a tru Davydov procedure. Won't have to spend a bunch of  money flying all over the country. I already put in a consult inquiry with Dr. Gallagher so hopefully she wont be booked to far out. Did you have any issues with insurance coverage?

Hello
No I did not have trouble with the insurance I currently have. My spouse has it through her work and it follows Illinois state guidelines and has a 'transgender surgical' policy. I had to meet all of the requirements (WPATH guidelines) and the staff at IU Health University Hospital took care of getting all of the approvals done.
If you have your letters then submit them all to Dr. Gallagher's office and they will start the process. It does feel like forever getting through it all but I did get to the point of surgery in around 6 months from the start so not too bad. And that was with waiting to see the urologist and everything.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on October 05, 2019, 10:30:24 am
Josie, you are in Illinois, and Dr Gallagher is in Indiana? Is this correct?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 05, 2019, 03:45:12 pm
Josie, you are in Illinois, and Dr Gallagher is in Indiana? Is this correct?

Yes.
We currently have a state employee policy that is also used by some Indiana state employees so IU Health was all 'in network'. This made it simple. Honestly I was amazed by how it worked out.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 09, 2019, 09:51:33 am
Update 4 weeks post op.

Healing continues. I do have some issues. Some of the skin around the vaginal opening did not make it. This is where those stitches dissolved. So in those areas I had that yellowish wound layer that is slowly loosening and pulling away. Under that is red 'granulation' tissue that can be sore, sometimes worse than others. I also have a bit of flesh that stands up in the middle of the bottom middle of the vestibule. My clitoris is also sitting high and not covered by the skin hood. Now I still have plenty of deep swelling so nothing is settled into place yet. I do wonder if I will need a revision surgery later to fix up my cosmetic appearance. Dr. Gallagher said she would try to get it to turn out nice in the original operation but she did reserve that a second touch up might be needed later.

Internally everything is just fine. At my appointment last week Dr. Gallagher said the peritoneum was attached really well to the tissue and its just a cm or so from the opening.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on October 09, 2019, 12:54:50 pm
Hey Josie,

Sorry to hear you're having those problems. I hope the swelling goes down and everything hops into its proper place so you don't have to go under the knife again. Thank you for keeping us updated. Especially those of us who are planning our surgeries with the same doctor.

Hope you get better soon!

Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 17, 2019, 07:42:53 pm
5 weeks out

I do not need any lubricant to dialate. I have consistently been using the 3rd size and now the largest dialator in the SoulSource set. Some nerves are reconnecting. I strongly suspect that I will need a revision later. It seems like  stitches that were supposed to hold tissue in the floor of my vestibule must have been some of those that came out right away. I'll have to ask the doctor on my next visit.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on October 18, 2019, 02:44:42 am
Hey Josie,

Glad to hear that you don't need the lube. From everything I understand that is absolutely amazing!! I was already sold on having the same procedure that you had, but this makes me even more certain. As your nerves are reconnecting are you getting those little electric shocks I've heard about?

Sorry to hear that you're going to have to have that revision. Hopefully it won't be a bad one. Like maybe it can be done on an outpatient basis or something. I'll keep my fingers crossed for you!!

Glad to hear you're doing better.

xoxo
Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 22, 2019, 08:56:12 am
Another update.

I can now work with the largest size dialator. My depth is consistent at the last for on the dialator. I do not needto add any lube anymore. I just have to work it.
My outer labia are almost fully healed where the skin pulled loose and died off. I still think my cosmetic appearence will need a revision it not on my exterior, just inside my vestibule for regular appearance. I have deep swelling still under the outer labia, ect. that takes months to fully go away so there is no need to be too concerned just yet. Everything functions as it should so I'm quite happy with that. I'm also quite happy that the wound healing granulation tissue is almost fully converted to new skin.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: mm on October 22, 2019, 10:50:36 am
Glad your granulation areas are healing and feeling so much better, have raw tissue is no fun at all.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on October 23, 2019, 11:12:45 am
May your body heal perfectly Josie!
Glad that your progress sounds good, despite the issues.
Did the doctor give you an idea of when a revision is done, in the event it is needed?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Amanda Butterfly on October 24, 2019, 07:48:30 pm
Josie, do you know if Dr. Gallager has a blog or anything similar?  When I looked her up on the IU Health website it said that she was moving her practice to Miami at the end of December.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on October 25, 2019, 01:11:42 am
Hi @Amanda Butterfly

I'm planning on having my surgery with her hopefully next year, so I sure hope she's not moving. I know that since you're new here you can't send PM's yet, but after you reach 15 posts I think you can. When you get there, would you mind sending me a link to the site you're referring to please?

I tried to find it on the IU Health website but it didn't say anything about her moving. It did have buttons to click if you wanted to make an appointment though.

If you wouldn't mind doing that for me I'd really appreciate it!!

Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Amanda Butterfly on October 25, 2019, 03:31:25 pm
Is it permissible for me to post the link in a reply to this thread?
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on October 25, 2019, 05:45:45 pm
Hi @Amanda Butterfly

Sadly you can't post links until you've made 500 I think. But that's okay. I just got confirmation from another member. She said that Dr. Gallagher is indeed moving at the end of December. I'm so sad about that. I wanted her to do my surgery, and if she's way down in Miami then that will most likely rule her out.

But thank you so much for letting me know about that.

Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: autumnfaye_xoxo on October 25, 2019, 11:46:28 pm
I was on the consult waitlist and that news was a huge blow to me today. I found her new website for her private practice opening in Miami; Gallagher plastic surgery though I'm worried that she may not attempt to replicate this procedure with her new team and new location. Its very uncertain but seems like options are limited. I got on the new waitlist but at this point idk.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on October 26, 2019, 12:44:28 am
Yeah I'm taking it hard too. I thought I finally found the surgeon I was looking for. I'm like you, I don't know that she'll be able to recreate the same kind of surgery, especially since she's going private now. I guess only time will tell. Good luck with your consult, or whatever is your next step in the process!!  :)

Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 26, 2019, 09:28:55 am
I found her private website as well as the notice on IU Health's website. I am sorry she is moving. It seems like she has made so many advances there at IU. I am wondering if she will be affiliated with the Miami University gender program at all.
I have a revision I want her to do and I hope she can before she leaves and while I still have my insurance. Basically in creating the floor of the vestibule, she used the split lining of the urethra as many do. This is connected to a section of tissue that started out being stitched flat. However some of the stitches did not hold early on and it now kind of sticks upwards between the labia and below my clitoris. As the swelling beneath my labia skin goes down this piece of flesh is sticking out more now. I would think this might be an in office procedure. She originally said that we should wait 6 months before thinking about any revisions but I really want her to fix this before she goes.

Also noticed that she will not do consults after Dec 31st but she is not open in FL until March 2020 so she may have 2 months of surgical finish up work at IU Health. Just wish IU had another trained gender surgeon at all besides her to take over afterwards.  :-\
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Linde on October 26, 2019, 11:48:26 am
I found her private website as well as the notice on IU Health's website. I am sorry she is moving. It seems like she has made so many advances there at IU. I am wondering if she will be affiliated with the Miami University gender program at all.
I have a revision I want her to do and I hope she can before she leaves and while I still have my insurance. Basically in creating the floor of the vestibule, she used the split lining of the urethra as many do. This is connected to a section of tissue that started out being stitched flat. However some of the stitches did not hold early on and it now kind of sticks upwards between the labia and below my clitoris. As the swelling beneath my labia skin goes down this piece of flesh is sticking out more now. I would think this might be an in office procedure. She originally said that we should wait 6 months before thinking about any revisions but I really want her to fix this before she goes.

Also noticed that she will not do consults after Dec 31st but she is not open in FL until March 2020 so she may have 2 months of surgical finish up work at IU Health. Just wish IU had another trained gender surgeon at all besides her to take over afterwards.  :-\

I bet that she will be working with the university in Miami.  They had to fire their surgeon last year because of pictures of patients he posted on the net with rude and sexual remarks.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on November 02, 2019, 05:12:04 pm
So I saw Dr. Gallagher this week. Turns out everything is healing as expected. I have what seems like a big hump that is the opened urethra tissue that she kept for the vestibule floor. She said it often swells up that much and takes a long time but it will go down to a normal appearance in time. She had just one tiny spot she treated with silver nitrate for hyper granulation.
So I told her I no longer need lubricant to dialate. I have kept the depth from right after surgery. I can get up to the last for on the dialator. I can use the largest dialator in the set with a bit of care. She did the digital exam. With the peritoneum there are no internal skin graft incisions and so no scarring inside. So there is no pain when she does the digital exam. She was kind of surprised / happy about that. She asked if she could video the digital exam for her and the urologists records for their paper they intend on writing. I think the video was to show that she could do the exam in one motion and not have to stop for any type of scar tissue issues like skin grafts have commonly.

The gross sounding stuff: the moisture originally had an odor. They used gauss soaked in iodine for packing so for a while it smelled like iodine. Then as that faded I have to say it smelled , well like innards. A bit over 2 months and I am getting back to my normal odor from before surgery now. My need for maxi pads has reduced to just panty liners. I still have just a bit of external skin where the graft failed that is still healing. Overall it is all going really well.

She is moving to Miami. She said she hasn't decided for certain which hospital she will get surgical rights to. Three hospitals in Miami were trying to recruit her to work for them. So she will be in private practice but perform all surgeries in the hospital. She just won't be a hospital employee. She intends on continuing to offer this procedure as she said any good urologist can perform the peritoneal laproscopic portion. In hospital the patient gets the after care also of several nights. Basically exactly what care I had at IU Health in Indianapolis. She also is volunteering to train a surgeon for IU Health to take over the gender surgeries. The urology department also intends to be available to perform the procedure in Indianapolis. So if it all works out, IU will be able to continue to offer this surgery in the future as will Dr. Gallagher.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Lexxi on November 02, 2019, 11:33:22 pm
Hey Josie,

That sounds like a very good follow-up appointment to me. I'm glad everything's going so well, and that the bad smell is going away. That's also good news that she's going to continue doing the same surgery. I guess I'll be booking a trip to Miami sometime in the near future.

Thanks for the update!!

Lexxi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: autumnfaye_xoxo on November 04, 2019, 01:31:58 am
She is moving to Miami. She said she hasn't decided for certain which hospital she will get surgical rights to. Three hospitals in Miami were trying to recruit her to work for them. So she will be in private practice but perform all surgeries in the hospital. She just won't be a hospital employee. She intends on continuing to offer this procedure as she said any good urologist can perform the peritoneal laproscopic portion. In hospital the patient gets the after care also of several nights. Basically exactly what care I had at IU Health in Indianapolis. She also is volunteering to train a surgeon for IU Health to take over the gender surgeries. The urology department also intends to be available to perform the procedure in Indianapolis. So if it all works out, IU will be able to continue to offer this surgery in the future as will Dr. Gallagher.

Yay!! you are amazing and relieved so much of my anxiety hopefully you will be the first of many! This is a procedure that a lot of woman I'm sure are excited to have done and I'm really glad that you have done so well. Thank you for asking those question and gathering all this information.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: chinee on November 13, 2019, 01:22:22 pm
does the pheritoneal approach, would line the vaginal canal from bottom to the opening of the vaginal hole? My issue is most techniques, the opening part of the canal is skin so it doesnt get moist unless u put a lube.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on November 22, 2019, 05:20:29 pm
does the pheritoneal approach, would line the vaginal canal from bottom to the opening of the vaginal hole? My issue is most techniques, the opening part of the canal is skin so it doesnt get moist unless u put a lube.

Hi Chinee

So the way mine was done I have a short length of skin, less than a cm deep at the opening. The rest of the whole vaginal canal is a peritoneal tube. I need no lubrication for dialation. I do have to work the moisture up to the skin of my labia so the dialator will not pull on that skin as I insert them.

At this point I can say that when sexually stimulated my bulbourethral glands and prostate produce a good amount of thin clear lubricant fluid. This comes out of my urethra where in a cis woman the bulbourethral glands comes out on each inner labia before the vaginal entrance.
I'm not fully healed as I still have some stitches just inside my vaginal entrance and around my urethral outlet so any penetrative sex is not happening yet. From what I can tell using a bit of liquid lube with a partner may be needed for pleasurable sex but I think that depends on how stimulated I might be before penetration.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on December 29, 2019, 08:28:49 pm
Josie,
It would be great to have an update on how you are healing.
Thanks,
Jane
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Emmanymar on January 02, 2020, 07:13:55 pm
Would love to hear more about your healing  :)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: DebbySoufflage on January 02, 2020, 08:03:40 pm
Peritoneal vaginoplasty in trans women is still new. It has been performed in cis women for a long period though.

The surgeon who is most experienced in this area in the US is doctor Heidi Wittenberg who performs this surgery by help of a laparospic robot.

She takes insurance.
She is in San Francisco.

Dr Gallagher is a very experienced surgeon too though.
I have watched lots of her YouTube videos.
I just thought she was less experienced with peritoneal vaginoplasty than Dr Wittenberg. That's why I mentioned Wittenberg.

Dr Gallagher seems to make lots of publicity for zero depth bottom surgery.
According to Marci Bowers this is because surgeons who promote zero depth surgery are insecure about their own skills to create full depth versions. Not sure how true that is in Sidhb Gallagher's case. I for one think she is very knowledgeable.
She even offers customized clitorises.
A girl asked her if she could fashion her frenulum into a clitoris as this was the most sensitive part of her penis and Gallagher agreed to do that. She is innovative and open to new ideas.

Luv,
Debby


Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: SadieBlake on January 03, 2020, 01:37:09 am
 Pretty sure Dr bluebond-langer in NYC has performed more pptv procedures than Dr Wittenberg (I believe I was her 13th but no matter, it's well known engineers can't count accurately!0
). Dr bluebond-langer would have been an equal choice for me as Wittenberg, however she wasn't on my radar in 2016 when I was selecting a doc.

Copying from a redit post, these are the us surgeons presently doing pptv are

Dr. Bluebond-Langner at NYU
Dr. Ting (with Dr. Macie Bowers in certain cases) at Mt Sinai in NYC, (Bowers site mentions that she only does pptv with Ting in NYC, not at the other facilities where she practices)
Dr. Jonathan Keith in Newark, NJ.
Dr Heidi Wittenberg San Francisco CA
Dr Gallagher in IN and I guess soon in FL

I'm interested that for pptv, for now the majority of surgeons doing this in the US are women. This is not the case for the standard penile inversion / skin graft technique where women are a distinct minority.

Not the least surprised that it's the chicks innovating :-).

& Josie, congrats on your successful procedure! You've mentioned some problems with healing and I wanted to reflect that what you described happens more often than not among all the women I've known having GCS. I had.some stitches open up near the fourchette in my 2017 procedure and after my November pptv revision the same area is.the most tender bit. I hope it's continued to improve!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on January 07, 2020, 08:02:57 am
First an update:

Internal- Dialation is no trouble. I do not need lube to dialate. Internally everything is great.

External- While healing I had some tissues that pulled through the stiches. Like many doctors, Dr. Gallagher keeps the extra length of urethra from inside the penis to lay down and line the floor of the vestibule. Dr. Gallagher keeps this tissue connected at the urethral outlet. It seems like she kept a bit of tissue with this urethra making it thicker than I expected just urethra to be. Seems like it guarentes blood supply that way. So to explain my issue; on my left side the stitches held good. The urethra tissue healed down at the bottom of the labia like it should have. On right side the tissue pulled through those stitches. So this tissue is connected just fine at the middle underside but the right side stands out up to the upper tip. This seems all healed but this will need to be corrected. The tissue sticks up just a bit more than my labia and gets irritated by underwear and liners. If this had stayed down then she would have "hit a home run" as she said she was hoping to do.
My clitoris was a "custom" job. We spoke several times about what was sensitive for me and what was negative when touched. She and I came up with a way to use my lower side of my part as the exposed clitoris. Along with this I wanted a non-penial inversion on my external parts. We came up with a modification of Dr. Surpons Chonburi Flap design. I emailed Dr. Gallagher some sketches and it is exactly what she ended up doing.

IU Health University Hospital takes insurance. I was lucky as my spouse was working as an IL state employee. The insurance we had covered the surgery at 100%. Luckily that same insurance plan is offered by some MO and IN state agencies so the hospital in IN was a full participant in the insurance plan.
The hospital cash invoices were around $90k. The insurance actually paid about $40k.





& Josie, congrats on your successful procedure! You've mentioned some problems with healing and I wanted to reflect that what you described happens more often than not among all the women I've known having GCS. I had.some stitches open up near the fourchette in my 2017 procedure and after my November pptv revision the same area is.the most tender bit. I hope it's continued to improve!

Yes I did have skin graft death at that area because the stiches pulled and the skin graft did not get to establish good blood supply from beneath it. This took a while to heal but is really fine now.





So some other doctors have talked about using a peritoneal flap. Be careful in your research

Dr. Ting's notes that have been talked about does not use a peritoneal tube from a Davydov procedure. He uses the peritoneal tissue removed from the scrotum to line the inside of a penial inversion. This tissue surrounds the testicals as they push through the abdominal wall and drop. So Dr. Ting removes this tissue from the body and then grafts it onto skin placed inside the body.

Another surgeon at NYU has done a peritoneal cap procedure. They still do a penial skin inversion but leave the skin tube open. Then affix the skin tube to the abdominal peritoneal lining. This allows for the peritoneal cap to produce moisture inside but it is still a skin based vaginal cavity.

Dr. Bluebond-Langner at NYU and another surgeon together have done revision surgeries where a Davydov type peritoneal tube lengthened a failed penial inversion result. Similar but not a Davydov from the start.

Dr Heidi Wittenberg says she has done a couple on intersex patients where they lacked the needed penial skin to do a penial inversion. She talks positive about it in her videos but also brags about how she can do it all without another surgeon needed.
My thoughts on her video: she has gynocological specialization. Gynocologists hardly ever do work through the peritoneum. I know one who was concerned about me having the Davydov done because she thought the peritoneum was thin and too weak for vaginal construction. I had the urology chair and second doing my laprascopic portion at University hospital. When I presented my information to him earlier in the year, he talked about how he works in that area every day. He literally had 3 prostate removals through the peritoneum scheduled the next day. I would definitely find a GCS surgeon who works with a urologist to do the internal laprascopic part.

Dr. Gallagher has left IU Health University Hospital now. She says she will have her private practice open in FL later this year. She said 3 Miami hospitals wanted her to work there so she will have surgical rights at one or more of those. She plans to continue doing PPV procedures there with whatever hospital she works out of. She said she didn't want to go back to working as an employee in a hospital system again. Her sister who will manage the business end of her practice became available so they wanted to work together.
Dr. Gallagher and Dr. Koch (IU Health Urology chair) are going to publish a paper on me and the other two girls who got PPV last year.

IU Health plans to continue the PPV procedures after they have a new GCS plastic surgeon.

One thing both doctors said was just how simple and easy the procedure was. Dr. Gallagher said she was surprised and wondered why this hasn't been much more commonly done.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: zirconia on January 07, 2020, 10:01:16 am
Thanks, Josie

Do you know when Dr. Gallagher and Dr. Koch plan to publish the paper? I'd really love to be able to bring a copy as supporting material to my own surgical consultation later this year.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: SadieBlake on January 07, 2020, 02:05:42 pm
Really glad you're continuing to heal well. On how things are today, you're only 4 months post-op at this point and it sounds like your recovery is going really well.

My experience was that it took an entire year for everything to settle into place. My external appearance is substantially different from the 4 month mark, internally things evolved for a year also.

Dr Heidi Wittenberg says she has done a couple on intersex patients where they lacked the needed penial skin to do a penial inversion. She talks positive about it in her videos but also brags about how she can do it all without another surgeon needed.
My thoughts on her video: she has gynocological specialization. Gynocologists hardly ever do work through the peritoneum. I know one who was concerned about me having the Davydov done because she thought the peritoneum was thin and too weak for vaginal construction. I had the urology chair and second doing my laprascopic portion at University hospital. When I presented my information to him earlier in the year, he talked about how he works in that area every day. He literally had 3 prostate removals through the peritoneum scheduled the next day. I would definitely find a GCS surgeon who works with a urologist to do the internal laprascopic part.

Dr Wittenberg specialized in less invasive techniques and robotic assist long before she began doing trans procedures. I used to design the sorts of equipment she uses (not laparoscopic however we had a division that did that also). Based on her background I would be surprised if she hadn't already been up to speed on laparoscopy. Also, she learns *really* fast. The surgeons at Brownstein & Crane where she practiced this before cleared her to fly solo within a couple of months.

About working solo, I don't perceive any huge advantage for not having an assistant and a lot of upsides. Wittenberg works *really* fast and that's important in surgery. Then there's the mindset of surgeons generally and especially at that level. They are extremely good at what they do and having extra hands requires also communicating what those hands need to do. I have no idea if she would undertake PPTV solo the way she did my 2017 penile inversion. Certainly for the aspect that there's a fair amount of work being done in two locations, there will be some time savings in working in parallel (less in my case where the revision doesn't include any of the dissection of the old equipment, and the blunt dissection distance is substantially less.

She was clear that the surgeon assisting was there principally to train and she also that she was doing all of the major work. That's exactly what I wanted to hear; I trust her hands, cold though they are :-).


Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on January 07, 2020, 03:37:54 pm
That makes sense in some ways. However with what they did with me, Dr. Gallagher focused on the genital area while Dr. Koch used the Davinci robot to do the laproscopy. It was done pretty fast. I think about 3 hours start to finish. Having two makes sense with laproscopy as one is doing the internal freeing of the peritoneum and eventual cutting while the other is doing the resection and then uses the hook to pull the peritonium through and stitch it at the opening. Then the plastic surgeon keeps working on the externals while the urologist closes the vaginal tube with a purse suture and closes up the abdominal part .
Two surgeons each doing separate tasks that come to a single outcome. It's almost like having two surgeries done at the same time.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on January 07, 2020, 03:42:02 pm
Thanks, Josie

Do you know when Dr. Gallagher and Dr. Koch plan to publish the paper? I'd really love to be able to bring a copy as supporting material to my own surgical consultation later this year.

It has to go through the peer review process first so it will likely be late this year or early next.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Janna on January 11, 2020, 07:36:13 pm
Dr. Wittenberg has done 12 Davydov-style PPV operations so far, the oldest 13 months ago.  All patients satisfied so far.  She still considers PPV to be experimental but is willing to do it as a primary (non-revision) for patients that request it and who are well informed.  I know this because I paid $250 for a consultation and spoke to her directly.  She was actually really easy to talk to and full of information.

Unfortunately you will need health insurance for Dr. Wittenberg because the cash price for her PPV is $260-$300k.  She says that's because of the use of the laparoscopic robot but I'm not sure why it adds so much in her case (her penile inversion is $50k).  Two other doctors I've priced add 25-38% for PPV vs penile inversion.  She says the insurance to use with her is Blue Cross/Blue Shield PPOs.  Also, her waitlist is only a few months but she does still want genital hair removal even for PPV (unlike PriyaMED which doesn't require it) and that takes 6-12 months.

I've done about 80-100 hours of research and reading on PPV and other methods of vaginoplasty and have settled on PPV as my preferred method.  Unfortunately I'm currently with Kaiser Permanente health insurance and they don't offer it.  So I wrote them an article to try to convince them to offer it.  I can't post links but if someone wants a copy, PM me.  Their main SoCal GRS surgeon was surprisingly supportive but basically said they plan to offer it but probably not for 2-3 years.  Argh.  At least the PPV options are gradually expanding.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: cbraeburn on January 20, 2020, 01:59:27 pm
Dr. Wittenberg has done 12 Davydov-style PPV operations so far, the oldest 13 months ago.  All patients satisfied so far.  She still considers PPV to be experimental but is willing to do it as a primary (non-revision) for patients that request it and who are well informed.  I know this because I paid $250 for a consultation and spoke to her directly.  She was actually really easy to talk to and full of information.

Unfortunately you will need health insurance for Dr. Wittenberg because the cash price for her PPV is $260-$300k.  She says that's because of the use of the laparoscopic robot but I'm not sure why it adds so much in her case (her penile inversion is $50k).  Two other doctors I've priced add 25-38% for PPV vs penile inversion.  She says the insurance to use with her is Blue Cross/Blue Shield PPOs.  Also, her waitlist is only a few months but she does still want genital hair removal even for PPV (unlike PriyaMED which doesn't require it) and that takes 6-12 months.

I've done about 80-100 hours of research and reading on PPV and other methods of vaginoplasty and have settled on PPV as my preferred method.  Unfortunately I'm currently with Kaiser Permanente health insurance and they don't offer it.  So I wrote them an article to try to convince them to offer it.  I can't post links but if someone wants a copy, PM me.  Their main SoCal GRS surgeon was surprisingly supportive but basically said they plan to offer it but probably not for 2-3 years.  Argh.  At least the PPV options are gradually expanding.

Hi Janna,

I'm in the same predicament as you.  I have KP but am going to switch because they have denied my request for a BA.  Plus, I think PPV is the better way to go for GCS.  I'm approved for surgery with PriyaMED, but have also reached out to Dr. Wittenberg's office to see if they would consider me since I plan on having this surgery, regardless.  I'd love to share information/resources if you like - let me know.

Calista
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on January 20, 2020, 02:36:14 pm
Calista,

If I may ask:  Why did KP deny your BA?  I live in the San Francisco Bay area. Kaiser Permanente up here covers almost everything from electrology (face and down below), BA, GCS and FFS.  I am not sure what they do not cover.  Several of my friends have Kaiser and once they clear Kaiser's therapy process the surgical world seems to open up for them, I.e. if GCS is justified so are the other procedures, since GCS is usually considered the key surgery to transitioning, though this is rapidly changing. 

I had BA and my 10 day old FFS covered by Medicare.  I would think that you could appeal it, and/or get back in their therapy sessions and prove that your level of gender dysphoria is great enough to justify all needed transition related surgeries.  I also do realize tha KP does cover or not different things in different areas.  KP in the SF Bay Area seems to cover a lot, while not the same in southern CA in the LA area.

Thanks,

Allie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on January 20, 2020, 11:49:02 pm
Two other doctors I've priced add 25-38% for PPV vs penile inversion.

Thanks for all the great information.  Which other surgeons did you talk to?  I agree that PPV sounds like a great procedure.  There are only a handful of doctors in the US doing PVV, so I'd love to know more about them.

Thanks,
Jane
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on February 22, 2020, 06:48:29 am
Just an update

I am going to have a revision labiaplasty in March just before Dr. Gallagher leaves IU Health for FL. A number of surgeons use the urethra tissue from the penile area to line the bottom of the vestibule. Dr. Gallagher leaves it connected to the relocated urethral outlet with some flesh for blood supply. In my case the left side healed into place properly but the right side pulled through the stitches from the initial swelling and so this is standing outward on that side. She is going to reconnect it along that side so it properly stays in the bottom.
It seems that is the one issue I have had in my long term healing. I feel lucky about that. I know a lady who went to Canada and is still fighting with granulation and tears almost a year after her surgery.

The big positive to peritoneal lining is that I have never had any internal dialation pain. At first there was tenderness at my vaginal entrance where the external skin transitioned but that was the skin not the peritoneal tissue. I do produce intervaginal moisture. Enoughh I can dialate without any added lube. Basically like a cis girls vaginal secretions. I believe full epthilation of the tissue will be a while longer still.
The negative is that I am still needing to use daily wear liners. I thing the urethral tissue sticking up is part of that problem. Under the non connected edge seems to be where this is coming from so hoping this will decrease enough that I might get by without panty liners for everyday use. I know some cis women also use daily liners so I'm not in any way upset about it.

Disphoria has dropped so much now. I use public restrooms without worry now. I suppose I can describe it as feeling like I'm no longer stuck "faking" who I am. No more tucking. There will always be things I don't like about myself but generally just being myself in public with far less worries has been life changing.  ;)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: mm on February 23, 2020, 11:27:53 pm
You seem to have great results with this one little problem that is being taken care of now. Many cis girls do wear a mini pad at least part of every month.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: SadieBlake on February 27, 2020, 06:32:27 am
Josie, I'm glad you mentioned not needing lube because it prompted me to have a try at dilation without and I'm really glad to say it worked fine :-). I will still need a good lube for the largest dilator (presently green), as even with the best lube I have, I find it sticks in the peritoneal section sometimes (quite painful to get it moving.when this happens). I still exude a lot of fluid, more when I dilate with the larger dilator. Im letting. My underwear take care of it because pads seem to cause more friction / discomfort.

Happy progress!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on March 03, 2020, 09:27:11 pm
I had labiaplasty yesterday. Besides refastening that tissue down, Dr. Gallagher did a bit the same on my clitoris as it was setting near the outer surface. She also made a verticle incision to pull the skin in and make my outer labia cover my clitoris and basically added some definition to my labia minora. I have had almost no pain. When I sit up too much it adds some pressure on that upper incision so I have to watch that but otherwise no pain. Once this is healed I should be in all done down there.

I did have to pay for this surgery myself. It totals around $4000. I also got a slight surprise bill from my initial GCS surgery. The insurance I had then was supposed to cover GCS at 100% except for a $350 facility fee. But they appearently did not pre-approve the second urologist who was there. There were extra doctors involved since this was a new thing. A second urologist was in the OR observing but he still gets to bill his time. Now I will have to pay another $700 for his fees that were not approved by the insurance.
Well it's still better than paying for the whole billed amount of nearly $90k or the actual insurance paid amount in the low $50k range.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: autumnfaye_xoxo on March 24, 2020, 11:47:29 am
Dr Gallagher’s sister reached out to me today for information on consultation. That was rather frustrating because Gallagher requires referrals from providers addressed to Dr. Gallagher before she will schedule a consult and that’s a rather hard thing to get in the midst of the current Pandemic.

I reached out to Gallagher on Facebook and mentioned my concerns with that information but then asked in regards to peritoneal procedures:

“We won’t be able to operate for quite some time and you are right we are not yet offering the peritoneal procedure in Florida as we are still looking for the right robotic surgeon to collaborate with. I apologize we won’t be able to (in the near future) do that procedure.”

So at this time looks like I’ll have to wait unfortunately.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: boddi on March 26, 2020, 01:59:49 pm
Hi all, does anyone know the depth of peritoneal GCS?    I had a PI with good depth, but am considering an 'upgrade', which may seem drastic to some, but I would like more depth and the other benefits of this technique. 

  Do you think they would resuture my original sutures?  Also, anyone know cost?  I am in Europe.  Thanks
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Megan. on March 26, 2020, 02:50:03 pm


Hi all, does anyone know the depth of peritoneal GCS?    I had a PI with good depth, but am considering an 'upgrade', which may seem drastic to some, but I would like more depth and the other benefits of this technique. 

  Do you think they would resuture my original sutures?  Also, anyone know cost?  I am in Europe.  Thanks

There is no general limit, beyond internal space - unless you're a human tardis lol.

If you have a partner for whom your current depth is a problem, then frankly, i'd say that's their problem :-).

Sent from my MI 9 using Tapatalk

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Megan. on March 26, 2020, 02:55:14 pm
I'll add that - to my knowledge - no UK surgeon currently offer peritoneal GRS if that's what you are seeking?

Sent from my MI 9 using Tapatalk

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on March 26, 2020, 03:03:45 pm
I Think that there is a doctor in Spokane, Washington that does revisions using the the PI technique.  There was a thread here not to long ago about the doctor.  Do a search and you may find his name and website or other contact info.  Good luck.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: KatieP on March 26, 2020, 08:36:37 pm
I Think that there is a doctor in Spokane, Washington that does revisions using the the PI technique.  There was a thread here not to long ago about the doctor.  Do a search and you may find his name and website or other contact info.  Good luck.

The doctor in Spokane is likely Geoffrey Stiller at Stiller Aesthetics. I don't know all the techniques he uses, but it is more than two...

Katie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on March 27, 2020, 07:21:26 pm
I know the urologist who was in with the urology chair on these surgeries has intentions of being available to continue these at IU Health. But they still need a plastic surgeon who can take over Dr Gallagher's place there.

For those who want to know depth is about 7inches still. There is still more than enough moisture secretions. It seems the deeper parts may not have epthilized yet.

I am very happy with my results. I am healing up well from my revision done in early March.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on March 28, 2020, 08:01:00 pm
The doctor in Spokane is likely Geoffrey Stiller at Stiller Aesthetics. I don't know all the techniques he uses, but it is more than two...

Katie

Dr. Stiller is in Spokane.  He does the traditional inversion and a colon technique.  As of a few months ago he was not offering PVP.  His aesthetics results are amazing.  If he offered PVP I would seriously be interested.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: KatieP on March 29, 2020, 03:22:30 pm
Dr. Stiller is in Spokane.  His aesthetics results are amazing. 

I have heard this same thing a few times. But his website does not have pictures. I have not done an extensive search for pictures, but... How do you know his results are aesthetically amazing?

Thank you!

Katie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: autumnfaye_xoxo on March 30, 2020, 03:04:01 am
I know the urologist who was in with the urology chair on these surgeries has intentions of being available to continue these at IU Health. But they still need a plastic surgeon who can take over Dr Gallagher's place there.

For those who want to know depth is about 7inches still. There is still more than enough moisture secretions. It seems the deeper parts may not have epthilized yet.

I am very happy with my results. I am healing up well from my revision done in early March.


Well hopefully Dr. Gallagher finds a urologist or IU finds a plastic surgeon so this procedure can start taking place again soon.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on March 31, 2020, 12:41:02 am
I have heard this same thing a few times. But his website does not have pictures. I have not done an extensive search for pictures, but... How do you know his results are aesthetically amazing?

Thank you!

Katie

He does have photos.  They are under the body procedure tab of his website.  I have also heard lots of first hand reports. 
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: KatieP on March 31, 2020, 01:10:10 am
He does have photos.  They are under the body procedure tab of his website.  I have also heard lots of first hand reports.

Thank you, Jane!

I have heard several times about Stiller's great aesthetics, but always wondered what the proof might be.

That said, based on all this hearesay, and really enjoying his in-person demeanor, I have scheduled 22 May with him. I do hope he is as good as everyone says...  ;D

Katie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Kara Lee on August 31, 2020, 08:41:00 am
I just wanted to share that I also had ppt at IU Health, less than a week post surgery right now. Dr Koch is still doing the robotic part within the abdomin and Dr Roth did the grs. Lol, with all the *plasty parts of the surgery I was just calling them all my multiplasties. The perionteal tissue was used to completely line my vagina.  Everyone I met during my week long stay was very nice.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: MikaelaA on August 31, 2020, 11:29:03 am
I just wanted to share that I also had ppt at IU Health, less than a week post surgery right now. Dr Koch is still doing the robotic part within the abdomin and Dr Roth did the grs. Lol, with all the *plasty parts of the surgery I was just calling them all my multiplasties. The perionteal tissue was used to completely line my vagina.  Everyone I met during my week long stay was very nice.

Hi Kara,

Thank you very much for sharing.  I would very much like to have the peritoneal procedure done as well.  Is Dr. Roth's first name Joshua?  Was it his office you initially contacted to schedule surgery?  I do appreciate any information you can provide.  Thanks again.

Mikaela
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on August 31, 2020, 02:48:08 pm
I believe Dr. Roth first name was Joshua. He was the second urologist in on my surgery. Dr. Gallagher had said he was going to e part of the program.

I'm happy to hear that IU Health is still doing the PPV there. When I was there almost a year ago now, the hospital staff was all wonderful.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Kara Lee on August 31, 2020, 04:20:15 pm
Hi Kara,

Thank you very much for sharing.  I would very much like to have the peritoneal procedure done as well.  Is Dr. Roth's first name Joshua?  Was it his office you initially contacted to schedule surgery?  I do appreciate any information you can provide.  Thanks again.

Mikaela

Yes, that's his name. My primary care doctor referred me. Also, I think I was one of the last people to use IU Healths website tor their trans surgeries just before Dr Gallagher left. I would guess contacting them directly to find out their current procedures would be best.  I was trying to see them during their transition time between surgeons.

Like josie76 said, everyone there was very nice. The nurses and techs were all very patient with me and my slow gitupandgo :)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: MikaelaA on August 31, 2020, 05:02:42 pm
Josie and Kara, Thank you very much for your response.  I will call them tomorrow.  If there is any updated information regarding scheduling or anything related to surgery I will post it here.  Take care.


Hugs,

Mikaela
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 11, 2020, 12:01:25 am
Happy Birthday (1st anniversary after surgery) Josie76!

I respect you profoundly.because I read the forum entitled "Looking at peritoneal vaginoplasty with Dr. Gallagher".

Hope you "live" happily and healthy!

Nozomi (MTF in Japan)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Northern Star Girl on September 11, 2020, 12:06:14 am
@josie76
Dear Josie:
I agree with the  Happy (Surgery) ONE YEAR Birthday/Anniversary posting/comment
authored by @Nozomi

It appears from reading your postings starting back in September 2019 last year on this thread that all went well for you.
Thank you for sharing.

HUGS and best wishes,
Danielle
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Maddie on September 11, 2020, 07:23:29 am
If anyone knows a good way to reach this team, can you please let me know?
I have been trying to contact IU.  The website says they have no surgeon yet, and the voice messages still say Dr Gallagher.  I left messages for nurse Tara (not certain right name) which was the only voicemail box I found.  The submission forms to request entering their program require the surgery codes from the surgery team up front, so you can't fill the entry forms out without getting that info from someone there.
Been following this thread from day one.
Thank you so much.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: wildcat2083 on September 12, 2020, 09:48:33 pm
I am interested in  peritoneal vaginoplasty procedure, its a ways off for me, but all my research suggests this method is well uh a bit more natural and you have to have less maintenance during the long term aftercare, I live in the US and my insurance does claim they cover GRS GAS surgeries and didn't specify exactly a specific method and with that said while I am saving up could anyone provide me info on some doctors in the US who would perform this particular vaginoplasty vs the penile inversion (alone) idk if they are combined or what just know about less dialiation and more self lubricating and the uh texture is that of a cis-female. To me that seems like the right choice
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: SadieBlake on September 14, 2020, 07:51:01 am
I am interested in  peritoneal vaginoplasty procedure, its a ways off for me, but all my research suggests this method is well uh a bit more natural and you have to have less maintenance during the long term aftercare, I live in the US and my insurance does claim they cover GRS GAS surgeries and didn't specify exactly a specific method and with that said while I am saving up could anyone provide me info on some doctors in the US who would perform this particular vaginoplasty vs the penile inversion (alone) idk if they are combined or what just know about less dialiation and more self lubricating and the uh texture is that of a cis-female. To me that seems like the right choice

Assuming UI continues, that seems to be an option, the other two surgeons I'm aware of performing PPTV in the US are Bluebond-Langer in NYC and Wittenberg in SF. If you want details on my procedure with the latter (revision), pm me for a link.

I remain concerned about surgeons who enter into this work without adequate training. A group of concerned trans folk wrote an open letter to WPATH about this, seeking standards for training. For my part, I rejected the only local surgeon performing GCS for my primary vaginoplasty precisely for this reason, his training had consisted of observing only 3 procedures.

Now, surely, everyone starts somewhere, especially those who develop new techniques, that's not the same to me as beginning in a new specialty with minimal practice, I would be even moreso with respect to anyone undertaking something as complex as pptv without adequate preparation.



Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 15, 2020, 08:42:35 pm
@josie76
Dear Josie:
I agree with the  Happy (Surgery) ONE YEAR Birthday/Anniversary posting/comment
authored by @Nozomi

It appears from reading your postings starting back in September 2019 last year on this thread that all went well for you.
Thank you for sharing.

HUGS and best wishes,
Danielle


Thanks Danielle, and yes it has gone very well for me. :)
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 15, 2020, 08:52:33 pm
Assuming UI continues, that seems to be an option, the other two surgeons I'm aware of performing PPTV in the US are Bluebond-Langer in NYC and Wittenberg in SF. If you want details on my procedure with the latter (revision), pm me for a link.

I remain concerned about surgeons who enter into this work without adequate training. A group of concerned trans folk wrote an open letter to WPATH about this, seeking standards for training. For my part, I rejected the only local surgeon performing GCS for my primary vaginoplasty precisely for this reason, his training had consisted of observing only 3 procedures.

Now, surely, everyone starts somewhere, especially those who develop new techniques, that's not the same to me as beginning in a new specialty with minimal practice, I would be even moreso with respect to anyone undertaking something as complex as pptv without adequate preparation.

I would agree that being cautious about "new" doctors getting into doing trans surgeries.

About PPV surgery:
Dr. Koch commented that it was really a simple procedure from his part of working with the peritoneum. On my first office visit with him he had commented that he works inside that part of the body every single week. In fact the next day he had 3 prostate removals scheduled. He uses the robot to go through the peritoneum to get to and remove the prostate. His comment was that any urologist should have no problem doing that part. Still I would think that making sure the urologist is an experienced surgeon.

As for Dr. Roth doing the plastic part, seems he was in with Dr. Gallagher doing a number of those before she left IU Health University Hospital.

If anyone knows a good way to reach this team, can you please let me know?

I think you might want to try reaching out to the urology department at the IU Health University Hospital. There are several hospitals in the university system in Indianapolis. Search for Dr. Roth or Dr. Koch's office in urology there.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 15, 2020, 11:52:30 pm
Thanks Danielle, and yes it has gone very well for me. :)
I am glad that it gone very well for you.

My questions are indicated as bold underlined:

Last year I was 61 years old and I have booked a time for my SRS at another hospital this March. After that last December I found this forum and I emailed Emma (Coordinator of Dr. Gallagher at that time), but I could not get her reply. As I thought that this March was the last chance to get long vacation for SRS, I had SRS-1 Vaginoplasty without vaginal depth in Thailand by Dr. Kamol in March 2020 in order to avoid dilation.

But for younger Japanese MTF, I am very interested in the breakthrough PPV method that you developed with Dr. Gallagher and Dr. Koch, It will change the future of our MTF. I respect you profoundly.

Could you answer my questions?
1.   In your reply #124 in this forum at 6 weeks after PPV, “I can now work with the largest size dilator. My depth is consistent at the last for on the dilator. I do not need to add any lube anymore.” And in your reply #163 (at 6 months after PPV, “For those who want to know depth is about 7inches still. There is still more than enough moisture secretions. It seems the deeper parts may not have epthilized yet."
How about now after a year? Is it same as your reply #163 in this forum at 6 months?
Only if it's different, could you answer: How many inches? Enough moisture secretions? No lube required?

2.   Are the dilation frequency and the duration similar to the general ones below?
Only if it's very different, could you answer how often dilation is needed and how many months it is necessary?
Months Since Surgery   Diameter of Dilator     Frequency
0-3                           1-1/8"                       3X per day
3-6                           1-1/4"                       Once daily
6-9                           1-3/8"                       Every other day
9-12                         1-1/2"                       1-2x per week

3.   Dr. Wittenberg indicates in the video of “Dilating 101 part 2” in MoZaic Care of Dr. Wittenberg
(Though I just registered two weeks ago so I can't show each link directly, Could you search “mozaiccare video” in Google -> Videos | mosaic -> Dilating 101 part 2 (video)).
Is your dilation similar to it?

In your reply #148 in this forum, as for the paper of Dr. Gallagher, “it will likely be late this year or early next.”
In your reply #32, “One of the issues Dr. Gallagher had was several urologists who said it wasn't possible to do and less likely with a narrow masculine pelvis…. I gave him all of my research links and discussed it with him.”
So you developed your PPV method with them. I ask you.

4.   In your reply #15, “What we are talking about is a laproscopic Davydov Method vaginoplasty with full exterior reconstruction. This is what has not been done before last year in India. I have found cases published where a PAIS girls had it done where they had "ambiguous genitalia" so a reconstruction but with less than functional male genitals to start with.”
Could you indicate the differences between your PPV method and Dr. Mhatre’s method
in the Journal articles of “New laparoscopic peritoneal pull-through vaginoplasty technique” and
the YouTube of “PriyaMED presents... Sugar's PPV GRS SRS GCS Vaginoplasty”?

5.   Could you list the Journal articles and videos that are absolutely essential to add to Dr. Mhatre’s method?
For your convenience, could you select reference alphabets in your following list?
If there are other absolutely essential articles and videos, could you indicate them?

Video Resouces: (I just registered two weeks ago so the links were removed,)
A)   Badran, Osama. MD, Laparoscopic Neovagina Creation – with audio.
B)   Chittawar, Priya Bhave. Laparoscopic Vaginoplasty: Davydov's procedure.
Journal Articles:
C)   Marton, Ingrid., Habek, Dubravko., UjeviÄ, Boris. Laparoscopic Davydov procedure: 4 cases of neovaginoplasty. ISGE 25th Annual Congress & 4th Croatian Congress. 2016, May 25-28.
D)   Bianchi, Stefano., Berlanda, Nicola., Brunetto, Federica., Bulfoni, Alessandro., Caroggio, Celcilla., Fedele, Luigi. Creation of a Neovagina by Laparoscopic Modified Davydov Vaginoplasty in Patients with Partial Androgen Insensitivity Syndrome. The Journal of Minimally Invasive Gynecology. 2017, Nov-Dec. Vol 24, Issue 7, pages 1211-1217.
E)   Fedele, L., Frontino, G., Restelli, E., Ciappina, N., Motta, F., Bianchi, S. . Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome. American Journal of Obstetrics & Gynecology, Volume 202, Issue 1, 33.e1-33.e6.
F)   Giannesi, A., Marchiole, P., Benchaib, M., Chevret-Measson, M., Mathevet, P., Dargent, D. Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia.  Human Reproduction, Volume 20, Issue 10, October 2005, Pages 2954–2957,
G)   Jalalizadeh, Mehrsa, MD; Shobeiri, S. Abbas, MD, MBA. Davydov Procedure for Augmenting Vaginal Length in a Postsurgical Male-to-Female Transgender Patient. Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p e9–e11.
H)   Khadka, R.R., Islam, S., Rahman, S., Ali, Y., Salam, M.A., Hossain, M., Hasan, S., Vaginoplasty in vaginal agenesis associated with MRKH syndrome with tabularized peritoneal pull-through. A Journal of Bangabandhe Sheikh Mujib Medical University, Dhaka, Bangladesh. 2017, issue 10, pages 35-37. doi: 10.3329/bsmmuj.v10i1.31071
I)   Slater, Michael W., Vinaja, Xochitl., Islam, Aly., Loukas, Marios., Terrell, Mark., Schober, Justine. Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application. Clinical Anatomy. 2018. issue 31. pages 175–180.
J)   Takahashi, K., Nakamura, E., Suzuki, S., Shinoda, M., Nishijima, Y., Ohnuki, Y., Kondo, A., Shiina, T., Suzuki, T., Izumi, S., Laparoscopic Davydov Procedure for the Creation of a Neovagina in Patients with Mayer-Rokitansky-Kuster-Hauser Syndrome: Analysis of 7 Cases. Tokai Journal of Experimental and Clinical Medicine. 2016 Jun 20;41(2):81-7.

Best regards,
Nozomi

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Kara Lee on September 16, 2020, 12:51:29 pm
In addition to working alongside Dr Gallagher, Dr Roth also had fellowships in transgender surgeries at Ghent, University in Belgium as well as the Belgrade Center for Genital Reconstructive Surgery in Belgrade, Serbia.

I'm having a followup with him in a week and I'll ask him if they are ready for new patients and, if so, how to contact them.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 16, 2020, 08:32:24 pm
Could you answer my questions?
Best regards,
Nozomi

Hi Nozomi,

I will do my best to answer your questions.

1-2) no lubricant is needed for dialation. However due to complicated familial issues this spring I did not dialate as I should have. At 6 months I would say about 50-70% of the depth of the peritoneal lining was epthilized. Now I would say it is complete as no blood comes from that area after dialating any longer. With missing dialating sometimes as long as between 2 and 3 weeks I did loose some depth. Essentially that deepest portion had the time between dialating to heal together. The epthilized portion will not do that but what part is not yet epthilized can heal together quite quickly. Now as measured with a dialator I am about 10cm which still leaves me well within the average depth for cis women. Right now I am working back up to using the second largest dialator in the set. While I dont have any trouble in the peritoneal formed portion, the outer area where skin meets peritoneum has had some constriction with not dialating. I can use the second largest one in the set comfortably again.
In general maintaining one time per week now should keep everything fine for me now.

3)Did I develop it with them, not exactly. The Davydov Method has been around for 50 years. Honestly I had lucky circumstances. Dr. Gallagher had posted a YouTube video where she expressed her own interest in the concept. I commented on the video and she answered back. For a time this was as far as I could go due to cost of surgeries. Then at the beginning of 2019 my spouse started a job that had health insurance that fully covered GCS. It took some effort to reach out to the surgical coordinator working the clinic with Dr. Gallagher at first. However I had very specific questions which got passed on to the P.A. working in the clinic. She then had to pass them on to Dr. Gallagher. The PA sent me the responses. I came prepared to discuss PPV with Dr. Gallagher on my first appointment. She was very open to discussing the idea with me. She couldn't move forward then because she had to have a urologist.
A few more emails with the PA and Dr. Gallagher emailed me that she was meeting with her boss and the urology department to discuss it. After that meeting Dr. Gallagher's office made an appointment for me to see Dr. Koch. When I saw him he came in and said he didn't know exactly what was being discussed prior to him seeing me except he told the hospital supervisor he was willing to help Dr. Gallagher if he could. I had all of the PDF's stored on my phone so as I discussed it with him I could email him the documents and links. Dr. Koch opened a few documents and then opened a YouTube tab on the office computer. He was very interested once he saw what these videos showed surgeons doing. These videos all filmed the internal laproscopic camera which is exactly what he does every day. I left there with him saying he would look over the studies and videos and let myself and Dr. Gallagher know. The next week he stated he was willing to try it. Later Dr. Koch told Dr. Gallagher that is was a very simple and easy procedure from his end. She also said its surprising that it hasn't been the standard MTF method for years. I believe I was under for less than 4.5 hours.

So I didn't develop the procedure. I did do a ton of research and went in prepared to discuss it. Fortunately I found doctors and a univeristy hospital that were always looking to learn and teach new ideas.

Now I had some particular requests when it came to keeping my sensate region intact. Dr. Gallagher suggested I research the Chonburi Flap technic as one idea. Later her and I passed some sketches back and forth and it was essentially the way she did my reconstruction.

4) Dr. Matre's work was all done on cis female patients with Mullerian Agenesis. So he did not have to reconstruct the external genitals. He would create an incision where the vaginal opening should be and connect the pulled down peritoneum to there.
What was done to me was identicle internally. Dr. Gallagher had to do the regular MTF resection and then did a modified version of a Chonburi Flap to form my genitals.
To be specific: In a typical penial inversion, the tubular skin of the penis is fully turned inside out and the skin must be pulled down to the vaginal entrance position. Instead what was done was to cut an incision up the lower side stopping a distance from the end. This leaves a tube section of skin at the end but allows the penial shaft skin to be opened out into a semi flat sheet of skin. The flat section is left connected at the top of the base (dorsal side) so blood supply is maintained in the skin. The tube section left at the end is inverted forming a well shape. This forms the vaginal entrance. The peritoneum was then attached to this skin and underneath supporting tissue. Since the end skin of the penis didn't have any hair, no hair removal was needed. This method also did not require pulling and stretching the skin downward like in a penial inversion.

5) if you want to send me a PM through the site I can email the list with links still attached. The videos simply show multiple surgeons all over the world performing laproscopic Davydov procedures. The papers all apply to the basic method.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 16, 2020, 11:28:08 pm
Hi Nozomi,
I will do my best to answer your questions.
...
The papers all apply to the basic method.
Thank you very much for your very detailed and informative reply!! 
Please forgive me if I may ask again in the future about a few parts of your answer due to my lack of understanding.

For Japanese transwomen, could you reply your feelings of experienced people to the following questions?

6.   What is the minimum requirement for penis length for the PPV method you received? (How many inches?)

As for the issues in your replies #107, 109, and 120, you thought that it will take longer to heal on the outside.
7.   Do you think these are common things that happen to everyone?

You have been studying "the PPV method you received" for a long time.
I worried about peritonitis regarding PPV. The inside of the peritoneum is protected from the outside of the body, but if it is connected to the outside of the body by PPV, will the outside air flow into the abdomen?
8.   Would you please let me know if you have any comments?

In the article entitled “Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review”
As for Davydov vaginoplasty, “Functional success rates are reported as 92–93%, with a vaginal length of about 8.5 ± 1.6 cm and low intra‐ and postoperative risks. [11] After 6 months, vaginoscopy and biopsy results demonstrated the presence of iodine‐positive vaginal epithelium; [12] however, there is an increased risk of bladder or intestinal injury (3.8%), postoperative infections, and vaginal prolapse.[7] Further potential complications include a high rate of postoperative vaginal vault granulation (8.7%) and the risk of vaginal stenosis (5.1%). [7] With regard to later uterus transplantation, the suitability of the Davydov method is limited. In the case of postoperative failure, reoperations are difficult and are associated with intra‐abdominal adhesions. The feasibility of uterus transplantation may be impaired by the altered pelvic anatomical structures.”

In “Vaginoplasty: Peritoneal | mosaic”, Dr Wittenberg wrote as follows:
Risks of peritoneal pull-through procedure:
•All the risks of the penile inversion vaginoplasty
•Additional risk of an abdominal laparoscopic procedure, including intra-abdominal organ injury, ileus, herniation, and others
•Flap failure and stenosis
•Unknown long-term outcomes*
9.   Could you give your comments to possible complications and risks in "the PPV method you received"?

My question 3 of yesterday: Is your dilation similar to "Dilating 101 part 2 (video)”?
You can google search the video by "Dilating 101 part 2" AND Mozaic".

Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 17, 2020, 08:24:06 am
Thank you very much for your very detailed and informative reply!! 
Please forgive me if I may ask again in the future about a few parts of your answer due to my lack of understanding.

For Japanese transwomen, could you reply your feelings of experienced people to the following questions?



In “Vaginoplasty: Peritoneal | mosaic”, Dr Wittenberg wrote as follows:

9.   Could you give your comments to possible complications and risks in "the PPV method you received"?

My question 3 of yesterday: Is your dilation similar to "Dilating 101 part 2 (video)”?
You can google search the video by "Dilating 101 part 2" AND Mozaic".

Best regards,
Nozomi


Minimum penial skin length: As the way mine was done I would estimate that approx 2-3" of penial skin tube after "degloving" from the penial interior would be all that is required. Since this skin flap is placed directly downward the penial skin is used for the labia creation.

Dr. Gallagher uses the urethra opened up to form the floor of the vestibule. Many surgeons do this. However the one area that I am not thrilled about with my surgery is that Dr. Gallagher keeps some of the spongiform tissue attached to the urethra. This is semi erectile tissue. This has been my only complaint.

Yes healing the external skin grafts take the longest. For me the self dissolving sutures we dissolved very quickly by my body. This let the skin shift before it had fully reattached to the tissue underneath. So this resulted in some skin graft death and some granulation in those areas. This is what took longer. If the stitches had lasted longer then I might have healed quicker.

7-8) Internally healing happens at its own pace. The peritoneum will self seal if you don't stop it from doing so by dialation up until the internal surface epthilizes. The process of epthilizing seems to depend on air exposure. I was told to use a douche of warm water and a couple drops of iodine solution in the shower at first. Later this was not needed.

Risks: yes there are all the initial complication risks of having genital reconstructive surgery. Then there are risks of any laproscopic surgery. Having skilled doctors are the best insurance in either situation. My urologist uses a davinci surgical robot. He commented that it is like having his hands right inside the body where old laproscopic tools definitely require a very steady hand as those tools are around 2 feet long. If done correctly the Davydov has very low complication rate.

It may help to understand the way the Davydov is done. The surgeon must loosen the peritoneum from the abdominal wall area and the bladder. According to my doctor they do not try to loosen it from the back side around the large intestine. The doctor then finds the lowest place in the lower pouch of the peritoneal cavity. The GCS surgeon would have made sure there was an opening from the exterior and they insert a hook tool. This grabs the opening in the peritoneum and pulls this down. This forms a tube. The laproscopic surgeon then gathers the peritoneum lining together to close the new vaginal tube off from the body cavity and pulls it closed with a "purse suture". This leaves the vaginal tube connected to the main peritoneum lining maintaining blood flow. So this tissue is not "harvested" in a conventional sense but just pull down to repurpose it. The internal end of the vaginal tube is closed so no there is no leaking of the body fluids. The risk of death of the peritoneum vaginal lining is next to 0 as it remains connected to blood flow. Other methods may cut out and use tissue but this method does not remove it.

Vaginal stenosis risk is next to none so long as you dialate. Once the lining epthilizes it will no longer shrink or seal closed. This leaves just skin at the opening at risk of stenosis. Risks of bladder or colon perforations are dependent on the laproscopic surgeon. Vaginal vault granulation is essentially eliminated by using the PPV method.

Long term outcomes are well known for the basic procedure. What the medical community does not have is long term followups on trans-women with this method.

The one thing I can say is having a skilled laproscopic urologist is important. Dr. Koch works inside the peritoneum weekly. For him the procedure was very simple and easily done.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 17, 2020, 04:34:56 pm
Minimum penial skin length:...
The one thing I can say is having a skilled laproscopic urologist is important. Dr. Koch works inside the peritoneum weekly. For him the procedure was very simple and easily done.

Thank you very much for the detailed explanation that conveys the image!!

I am very grateful for your answer.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 20, 2020, 09:46:06 pm
1-2)…At 6 months I would say about 50-70% of the depth of the peritoneal lining was epthilized.

7-8) Internally healing happens at its own pace. The peritoneum will self seal if you don't stop it from doing so by dialation up until the internal surface epthilizes. The process of epthilizing seems to depend on air exposure.….
Once the lining epthilizes it will no longer shrink or seal closed.

10. I talked about PPV with a Japanese MTF friend.
She told that the peritoneal area is thin, so strong dilation is not possible, and there is a problem with sexual behavior.
I told her that the peritoneal tissues are epithelized and become almost indistinguishable from natal vaginal lining tissues after 6 month to a year.

What would you answer to her red words?

11.  In your reply #4 of the forum “Laparoscopic peritoneal pull-through vaginoplasty- testimonials, anyone?”,
“Some later studies following patients of peritoneal vaginoplasty showed that the peritoneal tissues become almost indistinguishable from natal vaginal lining tissues after 6 month to a year.
Is it Dr. Mhatre's paper of ”New laparoscopic peritoneal pull-through vaginoplasty technique”? If not, could you tell me the title of the paper? The Dr. Mhatre's paper is for ciswomen. Could you tell me the paper for transwomen?

12. The epithelized peritoneum is tough, right?

13. On the premise of the above quoted part, Before epithelization, should dilation be softly? How did you dilate in the very early stage and next duration?

Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 21, 2020, 08:19:43 am

Nozomi

Study list. I tried putting <dot> in place of an actual "." to kill the links.

Badran, Osama. MD, FACOG. Laparoscopic Neovagina Creation – with audio. 2012, Oct 30. Amman,
Jordan. www.drbadran.com. Video Retrieved from YouTube
Dr. Badran is a American Board Certified Gynecologist with a sub-specialty degree in Advanced Laparoscopic Gynecologic Surgery. He was chairman of the Gynecology Department at Interfaith Medical Center/New York 2001-2004 and has been a consultant in Gynecologic Oncology at King Hussein Cancer Center in Amman-Jordan since 2005. His private practice limited to advanced laparoscopic and minimally invasive gynecologic surgery. Dr. Badran demonstrates a laparoscopic Davydov procedure. This patient is female at birth. She has MRKH syndrome with fully formed ovaries but agenesis of the uterine and vaginal tissues. When Dr. Badran begins on the external genitals, it is clear the patient lacks even the vaginal introitus. Dr. Badran begins with an incision to open an introitus. He then opens the space for the vaginal canal until the dialator being used can be seen on the laparoscope pressing against the peritoneal pouch. This provides a visual location to open the peritoneal tissue inside. The peritoneal tissue around the incision point is mobilized. This does not appear to require a large area. After mobilization and opening to the new vaginal space, the peritoneum is grabbed and pulled down to the neo-vaginal introitus. The peritoneal tissues are sutured to the introitus. Then inside the laparoscopic surgeon uses a stitch to gather and pull the anterior of the neo-vaginal canal closed. This closes the peritoneal cavity as well. This case may be of particular interest as the patient has no existing vaginal introitus and therefore no existing depth to work from. This will be similar to a patient who is assigned male at birth from the external side.

Chittawar, Priya Bhave. Laparoscopic Vaginoplasty: Davydov's procedure. 2012, Oct 4. Video Retrieved from YouTube
Dr. Chittawar does a audio walk through of the procedure. She explains each step in detail as needed in this video. Dr. Chittawar explains several benefits to this procedure: Good vaginal depth. Does not require long term post operative dialation. Good epithelization from the peritoneal lining. Can be done by surgeon with average laparoscopic skill.

Dadhich, Chandra P. OBGYN. Laparoscopic vaginoplasty by peritoneal pull through by C.P.Dadhich. 2015,
July 3. Jaipur, India. Video Retrieved from YouTube
Dr. Dadhich performs a laparoscopic Davydov procedure. This patient is female at birth with MRKH syndrome. She has partial depth vaginal tissue.

Dadhich, Chandra P. OBGYN, Dadhich, Tripti. OBGYN. Dr. DADHICH technique of Peritoneal tube neo
vaginoplasty(5). 2019, Feb 17. Jaipur, India. Video Retrieved from YouTube
Dr. Dadhich demonstrates a laparoscopic Davydov procedure on a female at birth patient.

Watson, Jane. PriyaMED presents... Sugar's PPV GRS SRS GCS Vaginoplasty. 2018, Aug 24. Mumbia, India. Video Retrieved from YouTube
-The doctors in Mumbia, India demonstrate the use of a laparoscopic Davydov procedure on a trans-woman. They combine the pull through peritoneal technique with a non- penile inversion genital reconstruction. This patient is male at birth and has no visible signs of feminine skeletal traits. This patient has a normal male type pelvic structure. This is one of three patients to get this surgery in 2018. The hospital is opening this as a full option for GCS patients in 2019.

Journal Articles:

Bianchi, Stefano., Berlanda, Nicola., Brunetto, Federica., Bulfoni, Alessandro., Caroggio, Celcilla., Fedele, Luigi.
Creation of a Neovagina by Laparoscopic Modified Davydov Vaginoplasty in Patients with Partial
Androgen Insensitivity Syndrome. The Journal of Minimally Invasive Gynecology. 2017, Nov-Dec. Vol 24,
Issue 7, pages 1211-1217.

-This study reviewed a number of patients who had different grades of Partial Androgen Insensitivity Syndrome (PAIS). These patients are XY but have varying inability to react to androgen hormones. Androgen Insensitivity is divided into seven grades based on the degree of visible genital deformity effect. Currently the medical database has near 700 known mutations to the AR gene. This study was done by the Dipartimento di Ostetricia e Ginecologia e Universita degli Studi di Milano, Ospedale San Giuseppe, Milan, Italy and shows the Davydov procedure being used with genital reconstruction with patients who fit into ambiguous genitalia. Most lack any existing vaginal dimple or depth.


Fedele, L., Frontino, G., Restelli, E., Ciappina, N., Motta, F., Bianchi, S. . Creation of a neovagina by
Davydov's laparoscopic modified technique in patients with Rokitansky syndrome.

Giannesi, A., Marchiole, P., Benchaib, M., Chevret-Measson, M., Mathevet, P., Dargent, D. Sexuality after
laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with
uterine agenesis or hypoplasia. Human Reproduction, Volume 20, Issue 10, October 2005, Pages 2954–
2957

Jalalizadeh, Mehrsa, MD; Shobeiri, S. Abbas, MD, MBA. Davydov Procedure for Augmenting Vaginal Length
in a Postsurgical Male-to-Female Transgender Patient. Female Pelvic Medicine & Reconstructive Surgery:
July/August 2018 - Volume 24 - Issue 4 - p e9–e11.

Khadka, R.R., Islam, S., Rahman, S., Ali, Y., Salam, M.A., Hossain, M., Hasan, S., Vaginoplasty in vaginal
agenesis associated with MRKH syndrome with tabularized peritoneal pull-through. A Journal of
Bangabandhe Sheikh Mujib Medical University, Dhaka, Bangladesh. 2017, issue 10, pages 35-37.

Marton, Ingrid., Habek, Dubravko., UjeviÄ, Boris. Laparoscopic Davydov procedure: 4 cases of
neovaginoplasty. ISGE 25th Annual Congress & 4th Croatian Congress. 2016, May 25-28.

Mahtre, Pravin., Mahtre, Jyoti., Sahu, Rakhi. New laparoscopic peritoneal pull-through vaginoplasty
technique. Journal Human Reproductive Science. 2014, Jul-Sept. Pages 181-186.

Slater, Michael W., Vinaja, Xochitl., Islam, Aly., Loukas, Marios., Terrell, Mark., Schober, Justine. Neovaginal
Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application. Clinical
Anatomy. 2018. issue 31. pages 175–180.

Takahashi, K., Nakamura, E., Suzuki, S., Shinoda, M., Nishijima, Y., Ohnuki, Y., Kondo, A., Shiina, T., Suzuki, T.,
Izumi, S., Laparoscopic Davydov Procedure for the Creation of a Neovagina in Patients with Mayer-
Rokitansky-Kuster-Hauser Syndrome: Analysis of 7 Cases. Tokai Journal of Experimental and Clinical
Medicine. 2016 Jun 20;41(2):81-7.

Images sourced, Laparoscopic Davydov Neovagina. Milkos and Moore.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 21, 2020, 08:35:40 am
10. I talked about PPV with a Japanese MTF friend.
She told that the peritoneal area is thin, so strong dilation is not possible, and there is a problem with sexual behavior.
I told her that the peritoneal tissues are epithelized and become almost indistinguishable from natal vaginal lining tissues after 6 month to a year.

What would you answer to her red words?

12. The epithelized peritoneum is tough, right?

YES, once epthilized it is quite strong and elastic. :) Rougher use of toys is quite possible.
Actually the peritoneum must be quite tough according to the urologist who did mine. Its tough enough to hold up when they use a laproscopic claw to pull it loose around the abdominal cavity. The claw looks like a alligator tooth wire clip.

13. On the premise of the above quoted part, Before epithelization, should dilation be softly? How did you dilate in the very early stage and next duration?

Dialation was explained to me simply. Insert the dialator and hold firm pressure against the end for about 20 min per session. Nothing but direct pressure. This keeps the vaginal canal open while epthiliaztion takes place.
Dialation is important as it prevents the peritoneum tissue from forming webbing and healing closed.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 21, 2020, 10:19:38 am
Nozomi

Not sure if these pics are OK but its one letter I sent to Dr. Gallagher when discussing this.


(https://live.staticflickr.com/65535/50368091786_b456dc0a97_z.jpg) (https://flic.kr/p/2jJRCTC)page1 (https://flic.kr/p/2jJRCTC)

(https://live.staticflickr.com/65535/50368250402_5814913998_z.jpg) (https://flic.kr/p/2jJSs3o)page2 (https://flic.kr/p/2jJSs3o)

(https://live.staticflickr.com/65535/50368091671_0041f08abd_z.jpg) (https://flic.kr/p/2jJRCRD)page3 (https://flic.kr/p/2jJRCRD)

(https://live.staticflickr.com/65535/50368250292_36b21c4acc_z.jpg) (https://flic.kr/p/2jJSs1u)page4edit (https://flic.kr/p/2jJSs1u)

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 21, 2020, 05:27:09 pm
Nozomi
Not sure if these pics are OK but its one letter I sent to Dr. Gallagher when discussing this....

My appreciation can’t be expressed in words for sharing your invaluable personal communication with figures.
You are great developer!
I understand "Not sure if these pics are OK".
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 21, 2020, 05:49:11 pm
YES, once epthilized it is quite strong and elastic. ...
13. ...Dialation was explained to me simply....

I appreciate your answers !
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 21, 2020, 05:50:53 pm
Study list. I tried putting <dot> in place of an actual "." to kill the links.

Thank you very much for sharing your study list.
It is extremely regrettable that it is buried in the comment section of youtube, and it is suitable for this site.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 25, 2020, 03:01:02 am
Nozomi  Not sure...

14.I found and saw all the Dr. Suporn presentation (Dec 2004) in last page of your letter. 
In your signature, “modified Chonburi Flap”. Could you tell me the details of the modification? Here, I realize your easy-to-understand following.explanation

For my procedure I had Dr. Koch the urology chair doing the laproscopic potion. They place 5 small incisions in my belly to insert a robotic surgical tool.
  Dr. Gallgher di the disassembly of the penile tissue. This is much the same for most surgeons. She kept the frenulum area per my request to make the clitoris from. This stays connected to blood vessels and nerves. She uses a length of the urethra from the inside of the penis as the vestibule floor. Also fairly common practice. My labia are made mostly of penile skin.
Internally, Dr. Koch went to the bottom of the space behind the bladder. Opened a small incision through the peritoneal  lining from the inside. He also had to loosen the lining from the inner wall of the abdominal cavity. This then allows them to insert a hook tool and pull the peritoneum lining down to the opening created by the GCS surgeon for the vaginal introitus. The pull the peritoneum down forming a tube and stitch this to the vaginal opening. The laproscopic surgeon then closes the tube inside the body with a "purse stich" suture. This closes the vaginal cavity while leaving it completely attached to the rest of the peritoneum. This way there are no concerns about loss of blood supply to this tissue.

15.   In your signature, “DaVinci robot laparoscopic Davydov”, I realize the benefits of robot.
Are there any precautions (areas or procedures, etc.) specific to PPV Da Vinci robotic laparoscopic surgery?

16.   If the penile skin isn't enough for PPV, could you please comment on the use of scrotal skin or inguinal skin to compensate it, as in Dr Suporn's presentation? Here I know you didn't need it, and you wrote as follows:

A number of doctors will use scrotal skin with this same type of tissue still connected to form the bottom part of a penile inversion as a standard practice. However you still have a length of regular penile skin first. Also neither surgical style does away with internal scar issues when healing.

From Dr. Suporn's description, the dorsal side of the penial skin is left connected at the base and layer in as the floor of the vestibule. Dr. Suporn makes a neoclitoris complete with frenulum and labia minora connected to the frenulum. From what I have found, he stops short of describing how he builds the vagina except he says he uses penial and scrotal skin. With a Peritoneal pull through the most that might be needed is skin at the vaginal introitus. I thought perhaps the end of penial tube after being degloved could form this if it is needed. I will know more when I see Dr. Gallagher again on my surgery day.  Anyway, the penial skin is thin and has no subcutaneous fat so it is ideal to create the labia minora, and clitoral hood out of.



Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on September 25, 2020, 05:50:23 pm
Nozomi

14) my surgery was done almost as I had drawn the pictures in my letter. Dr. Gallagher did keep the frenulum and that skin is exposed right were the clitoris should be.
The difference: Dr. Suporn makes the frenulum into a small structure looking just as a cis clitoris. He gathers skin to shape labia minora on each side and connects that skin fold to the frenulum on each side of center. When healing occurs this leaves a very natal appearance to the neo-clitoris and labia minora. Dr. Gallagher however also keeps opened urethra to line the bottom center with. Many other surgeons also use this. Dr. Gallagher leaves some of the corpus spongisium behind the urethra. This has been the one issue for me. I think there is too much of this tissue there since it is semi erectile.

15) no there is nothing specific to robotic surgery. For the doctor this is far more precise and likely safer for the patient than the old style laproscopic tools used. The old tools are each about 2 feet long and the surgeon must operate them from the one end with their thumbs. The robotic surgery makes the surgeons control much more stable inside the body.

16) since the vaginal canal is made of peritoneum and not skin, very little penile skin is needed. For the most part skin is only used for the external genital reconstruction. If skin is in short supply then areas of the inside of the vestibule can be made of peritoneum as well. Otherwise scrotal skin could be used.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on September 25, 2020, 09:19:34 pm
Nozomi 14) 15) 16)

As my posts are less than 50, I can not give reputation points.
So I wish to offer my immeasurable gratitude to you not only for this answer, but for all your answers so far.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 05, 2020, 11:37:14 pm
So Dr. Gallagher used to require clearing of hair. Now she does not.

Dear Josie,
17.   Would you please select numbers from the list below that is not included in preoperative requirements for your PPV surgery at IU Health? 6,

In “Vaginoplasty: Peritoneal | mozaic - Dr. Heidi Wittenberg”.
PREOP REQUIREMENTS for peritoneal pull-through vaginoplasty include:
1. Three letters (2 from mental health professionals, 1 from a hormone provider or primary care doctor).
2. Overall good health.
3. No smoking, nicotine, or any other inhalational products (including second hand smoke) around 3 months before and after surgery. This can cause about a 5-fold increase in complications. Patients who smoke within this 3 month window before surgery may be rescheduled for a later time when then they have reliably stopped smoking.
4. Perioperative assistance (friends, family, hired help).
5. Surgical technique, anatomy, and genetics dictate most of the individualized aesthetic results.
6. Hair removal (same guide for a vaginoplasty procedure).
7. No prior abdominal mesh surgery.
8. No prior exploratory laparotomy for trauma.
9. No prior history of pelvic radiation.
10. No prior history of inflammatory bowel disease. No Crohn's disease, ulcerative colitis, or diverticulitis.

Minimum penial skin length: As the way mine was done I would estimate that approx 2-3" of penial skin tube after "degloving" from the penial interior would be all that is required. Since this skin flap is placed directly downward the penial skin is used for the labia creation.

16) since the vaginal canal is made of peritoneum and not skin, very little penile skin is needed. For the most part skin is only used for the external genital reconstruction. If skin is in short supply, then areas of the inside of the vestibule can be made of peritoneum as well. Otherwise scrotal skin could be used.

18.   “Approx 2-3" (Personal Estimate) of penial skin tube after "degloving" is preferable. If skin is in short supply peritoneum or scrotal skin supplements it. So penis length is not preoperative requirement.” Is my understanding correct?

19.   Could you please indicate numbers that does not apply to your PPV at IU Health in the following points?

In “Vaginoplasty: Peritoneal | mozaic - Dr. Heidi Wittenberg”.
Potential benefits of this option (peritoneal pull-through procedure):
1.   Self-lubricating lining with some elasticity
2.   Less need for dilation (compared to that of the penile inversion technique)
3.   Less need for douching
4.   Less preop hair removal
5.   More vaginal depth
6.   Lower risk than colonic vaginoplasty
Risks of peritoneal pull-through procedure:
7.   All the risks of the penile inversion vaginoplasty
8.   Additional risk of an abdominal laparoscopic procedure, including intra-abdominal organ injury, ileus, herniation, and others
9.   Flap failure and stenosis
10.   Unknown long-term outcomes*

Dr. Ting's notes that have been talked about does not use a peritoneal tube from a Davydov procedure….
Another surgeon at NYU has done a peritoneal cap procedure. ,,, but it is still a skin based vaginal cavity.

20.   Yesterday I found “overview for Setiku – R...”: In it,
“Djordjevic in Serbia, Houtmeyers in Belgium. Outside of USA and Europe are Kamol in Thailand and PriyaMed in India”
“…I'm personally leaning towards Kamol for the peritoneal option, he is currently my strongest contender,…I think there are multiple variants of peritoneal as a technique - the one described in the Susan's thread 2) seems to not be 'pull-through',”
though the description in SRS-PPV (Penile-Peritoneal Vaginoplasty) of “MTF Sex Reassignment Surgery - Kamol Cosmetic Hospital” seems to be similar to that of PPV. I have shown the part below 1) for your convenience.
I was able to confirm that the lower half of the vaginal tube was made of penile skin and the upper half was made of peritoneum.
As shown in the above quote, you have commented on Ting and others.
Would you give me your comment to the followings?
A) Can it be expected that “half the peritoneum and half the penis” will keep dilation easier?
B) The potential risk of “half the peritoneum and half the penis”
C) The points to distinguish between the surgery that has the “potential benefits” in question #19 and those does not have them


1) Penile-Peritoneal Vaginoplasty technique (SRS-PPV) (2020-10-05 14:17. This PPV is new at Kamol, so this page may be updated, pink is my comment.)
           This technique is the most current advanced technique and innovation of neovaginoplasty for transwomen. The peritoneum is cut and pulled through the neovaginal canal with laparoscopic method. The penile skin sutured with the peritoneum at the neovaginal entrance.
           The neovagina will have self lubricate resemble the biologic female. The neovagina is less chance of shrinkage, less chance of vaginal prolapse. It needs vaginal dilation less than skin graft or colon technique due to the nature of the peritoneum mucosa. This technique is a benefit for those who have chronic colitis (Crohn’s disease) or chronic diverticulitis. Also, that's no hair growth at the deep part of the neovagina. Using combined penile skin and peritoneal mucosa technique will decrease excessive mucous and less chance of prolapsed penile flap. The operation time takes 4-6 hours.
Advantages:
1.   This technique can use as a primary or secondary neovagina reconstruction.
2.   This technique is beneficial for patients who have previously undergone sex reassignment surgery, penile inversion whose vaginas have become a loss of depth, and are unable to perform sexual intercourse.
3.   The vagina has a self-natural lubricant.
4.   Easier to do vaginal dilation than skin graft technique.
5.   Fewer risks of intestinal dysfunction compare to the sigmoid colon.

2) I searched the Susan's thread, but I could not find it.
PPV of SRS at Kamol Hospital began in 2020 (practically after summer).
But I could find only
https://www.susans.org/forums/index.php/topic,245400.msg2263812.html#msg2263812 June 12, 2019, FSS not SRS
https://www.susans.org/forums/index.php/topic,234185.msg2216794.html#msg2216794 January 21, 2019
https://www.susans.org/forums/index.php/topic,237694.msg2141209.html#msg2141209 original quote is May 30, 2018 and deleted
the others are older than the above posts.
 
Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 06, 2020, 10:03:40 am

Nozomi,

17) items not required at IU Health
-hair removal; I had no removal required as the penile skin has very little hair except at the base. This may vary for some patients. Since the end of the skin tube formed the introitus there was no hair issue.

-No prior abdominal mesh surgery; I had previous hernia surgery and had a mesh and staples, no problems
(https://live.staticflickr.com/5590/30614889434_590f5b1cc6_w.jpg) (https://flic.kr/p/NDkj2h)image (https://flic.kr/p/NDkj2h)
You can see the staples are the shiny dots in this CT of me.

-No prior exploratory laparotomy for trauma; Again my urologist said no problem with my hernia repair surgical hardware so not an issue

-No prior history of pelvic radiation; no idea about this one

I do not know the doctors opinion of inflamatory bowl syndromes.


18) yes, if needed any skilled surgeon can pull the peritoneum further down and out or they can harvest the same type of tissue from inside the testicular bag. When the testes push through the abdomen they pull along a bag of peritoneal tissue from the abdomen.


19) things that do not apply
9; really failure of peritoneal flap should have a zero occurence when done as the davydov procedure. This is because the peritoneal lining is still connected completely to the abdominal main part of the peritoneum. All blood flow continues as normal through this tissues. external skin flap death does happen. I had places the dissolving stitches were destroyed too quickly by my body and the skin pulled back opening the underlayer of tissue. The skin that pulled back died since it had not fully connected new blood vessels from the tissue under it. This causes granulation to then form until it heals in as new skin. This was all external issues for me.
10; Dr. Milkos and Dr. Moore have been doing the Davydov in the US for three decades now. They just didn't perform it on trans patients. Medical outcomes are well known for this surgery. The warning from some doctors is simply when it comes to "transwomen" there is very little history. There has been some documentation of it being used on higher grade PAIS patients in liue of colon or illeal types of surgeries.


20)
A) Using the peritoneum as just the bottom half may make dialation easier. You still have to get past the point of granulation at the edge of the skin to peritoneum transition. If this area proves an issue then the peritoneum depth may be lost as without dialation it will heal closed. This is until full epthiliation has happened. On the positive side, with the deeper half pertoneum there will be no pain from granulation at full depth.

B)I could see a potential risk early on of the skin having granulation at the joint and possible tear. That would be similar risk to a all skin spliced with scrotal skin penial inversion where there are deep joints with skin flaps.

C) The way mine was done, the skin and peritoneum meet right at the first layer of pelvic floor muscle. This I think provided a very good underlying tissue to joint both part to. This makes the skin section very shallow and the remainder full peritoneum. This point has also been my only issue when I skipped dialation for several weeks due to some extreme personal family issues happening around me. I am getting back my girth and depth now with dialation.

A surgery that does a full penial inversion and then joins peritomeum to it still has advantages over just skin inversion. However there will be risk of issues at the deeper tissue joint while healing. There is more potential for issues of hair depending on the patient and the length inverted. Penial inversion requires pulling the skin on the outside much more as well and there are issues possible with the seems there and with needed further skin removal later.

Dr. Ting has done a graft of peritoneum tissue removed from the testicular pocket. His version required removing this tissue from the body then grafting it as an internal layer to a skin graft. This placed peritoneum like lining into a skin made vaginal cavity.
Another NYU doctor has done some with simply stitching the ends of the open inverted skin tube to the abdominal peritoneum. Essentially this makes a peritoneum cap at the end of a skin made vaginal cavity.
Since then NYU has also done some Davydov style revisions of low depth penial inversions. I have not read that they have done any as the full primary surgery.

Risk wise, with a capable urologist there is far less risk with a Davydov than with either an illeal (small intestine, almost never mentioned in literature for some years) or colon. Colon has been done by some surgeons with decent results. However the risk of cutting a section of colon out and then making the two ends of the original connect back together without leaking potentially harmful bacteria is quite higher.

The more of the peritoneum that can be used for the vaginal cavity the better I think. It doesn't "feel" like skin. It quite literally has the tactile surface of a cis vagina.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 06, 2020, 04:23:32 pm
Nozomi, 17) 18) 19) 20)

Thank you very much for your reply.
From the bottom of my heart,
I'm very glad to hear your deep insight.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 06, 2020, 04:32:08 pm
I found studies before that compared ileal (small intestine) to peritoneal when used for Mullerian agenesis and CAIS and upper grade PAIS patients. Both performed as expected but the study showed significantly lower blood loss and complication risk with peritoneal. Surgical times were also much shorter. Some later studies following patients of peritoneal vaginoplasty showed that the peritoneal tissues become almost indistinguishable from natal vaginal lining tissues after 6 month to a year. This is because the outer layers of the peritoneal tissues have epidural like cells for the membrane but continue to allow the inner cells secretions through. The secretions are pH similar to natal vaginal secretions as well.

All of the studies following cis girls who had the Peritoneal method for Mullerian agenesis has shown that not only does the peritonium become indistinguishable from natal vaginal lining cells but that the natural secretions take on the same natural pH and the same microflora as a cis vagina.

Dear Josie,

21.   I searched based on the words in these quotes. but I could only find references A and B below. I've added a long quote at the top to help you remember which document it came from.
Could you please show me the supporting paper, especially indicating that secretions are pH similar to natal vaginal secretions?

A)   Dr. Mhatre’s “New laparoscopic peritoneal pull-through vaginoplasty technique” (PMCID: PMC4229793)
“The peritoneal lining changes to stratified squamous epithelium resembling normal vagina and having acidic Ph.”

B)   “Analysis of the artificial vaginal microecology in patients after laparoscopic peritoneal vaginoplasty”
(PMCID :PMC6560037)
“approximately 57.4% of the patients had vaginal pH ≤ 4.5”
“as time goes by, the artificial vaginal microecological condition gradually becomes normal.”

22.   In the latter paper B,
“39.1% of the patients who had the operation at least 2 years ago exhibited dysbiosis”
“In patients with congenital vaginal atresia who have undergone laparoscopic peritoneal vaginoplasty, the vaginal microecology generated exhibits dysbiosis in varying degrees.”
“To understand the flora of the vaginal microecological condition after laparoscopic peritoneal vaginoplasty and explore appropriate adjunctive therapies, it will be beneficial to establish a normal vaginal microecology in an artificial vagina.”
Are you taking measures against dysbiosis as high as 39.1%? If so, what are your measures?

Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 06, 2020, 05:53:33 pm
I'll have to look for the other references but as far as dysbiosis, what you are really speaking of is bacterial vaginosis. There were things I did early on. Using a warm water dueshe bag with a couple drops of idiodine solution once a week. Daily dueshing with "hippacleanse" type body wash other days.

No now I have not needed to use either for some time.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 06, 2020, 08:55:16 pm
Thank you for your prompt reply to #22.
I'm sorry to have taken your time about #21.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 06, 2020, 11:01:08 pm
Nozomi, some info

"a study using a Kaplan-Meier analysis to assess the long term functional outcome of women who had undergone peritoneal vaginoplasty showed that good functional outcome and sexual activity satisfaction were near 100% one year after surgery, with continued sexual satisfaction in 80% of patients at 15 year follow-up.
The Female Sexual Function Index (FSFI), a brief questionnaire measuring sexual function in women encompassing six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), revealed no significant difference between patients of laparoscopic pelvic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty (Cao et al., 2013; Wu et al., 2016)."



"there are many advantages of using a pelvic peritoneal flap for SRS. Owing to its anatomical location within the body and close proximity to the neovaginal introitus, the neovagina has a natural axis suitable for sex, there is no danger of flap necrosis or failure of a graft to take, and it allows for a minimally invasive approach with minimal scarring, which is a distinct advantage (Rangaswamy et al., 2001)."


Zhou JH, Sun J, Yang CB, Xie ZW, Shao WQ, Jin HM. 2010.
Longterm outcomes of transvestibularvaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
FertilSteril 94:2281–2285.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome
The Journal of Minimally Invasive Gynecology 2009
DOI: 10.1016/j.jmig.2009.07.018
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 07, 2020, 03:04:37 am
Thank you very much for the information.
Especially the first !
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 07, 2020, 05:36:26 pm
"a study using a Kaplan-Meier analysis ...
"there are many advantages of using a pelvic peritoneal flap for SRS. ...
Longterm outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome

Dear Josie,

I got that the 1st and the 2nd important paragraphs are from the 4th (Neovaginal Construction with Pelvic Peritoneum).
Your pickup is essential.

The 3rd includes evidence of the 1st.

The 5th includes concrete evidence, indicating "Laparoscopic Davydov is a safe, effective treatment of Mayer-Rokitansky-Kuster-Hauser syndrome with minimal invasion and a relatively low complication rate."

Thanks again.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 08, 2020, 08:02:43 am
Yes the first and second were quotes from that citation.
Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

those paragraph also reference earlier studies
Cao, et al, 2013
Wu, et al, 2016
Rangaswamy, et al, 2001


Cao L, Wang Y, Li Y, Xu H. 2013. Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.
Int Urogynecol J 24:1173–1179.

Wu J, Guo R, Chu D, Wang X, Li L, Bian A, Zhao Q, Shi H. Comparison of two techniques of laparoscopy-assisted peritoneal vaginoplasty.
J Minim Invasive Gynecol. 2016 23(3):346–51.

Rangaswamy M, Machado NO, Kaur S, Machado L. 2001. Laparoscopic vaginoplasty: using a sliding peritoneal flap for correction of complete vaginal agenesis.
Eur J ObstetGynecolReprod Biol 98:244–248.

---------------------------------------------------------

Then some other citations used in that paper

Marques Hde S, dos Santos FL, Lopes-Costa PV, dos Santos AR, da Silva BB. 2008 Sep. Creation of a neovagina in patients with Rokitansky syndrome using peritoneum from the pouch of Douglas: an analysis of 48 cases.
FertilSteril 90:827–832.


-------------------------------------------------------------------
then repeating the first ones from above to make a more complete list.

Zhou JH, Sun J, Yang CB, Xie ZW, Shao WQ, Jin HM. 2010.
Longterm outcomes of transvestibularvaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
FertilSteril 94:2281–2285.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome
The Journal of Minimally Invasive Gynecology 2009
DOI: 10.1016/j.jmig.2009.07.018


Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 08, 2020, 04:23:25 pm
Thank you very much !

I read those Abstracts of first 4 papers that are new to me,
and am particularly interested in Cao's paper.
This shows some of the advantages of laparoscopic peritoneal vaginoplasty over laparoscopic sigmoid vaginoplasty.

Thanks
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 10, 2020, 10:13:11 pm
Dear Josie,
23.   In the web of “Peritoneal Pull Through Vaginoplasty Procedure - Dr. Heidi ...”
“Peritoneal pull through has the theoretical benefit over the penile inversion technique of having lubrication, needing less dilation, less douching, less maintenance, and more depth.
This option may be less risky than sigmoid colon vaginas; not having the risk of anastomosis breakdown, having less risk of prolapse, not having odorous mucus discharge, no need for monitoring colon pathology.”

The benefits over the “Penile Inversion Vaginoplasty” and the benefits over “Sigmoid Colon Vaginoplasty” are discriminated.
So I added P or S to below.
Here, P is the benefits over the “Penile Inversion Vaginoplasty” and S is the benefits over “Sigmoid Colon Vaginoplasty”

Could you add S or P to the underlined part, respectively? For example, if requiring douching with PPV is less than that with Sigmoid Colon Vaginoplasty, please add S:  As a result, “4. Requires less douching PS
In the web of "Vaginoplasty: Peritoneal | mozaic - Dr. Heidi Wittenberg", #3 seems to be P, and the others seems to be PS.
but #3 is the most important question for me:
If dilation with PPV is less painful and easier than dilation with sigmoid vaginoplasty, please do add S to 3.

Please copy the following and paste to your reply field. So you don't have to change the color yourself.

Potential benefits of PPV (some updated according to the web of “Peritoneal Pull-Through Vaginoplasty - MTF Surgery”)
1.   Self-lubricating lining with some elasticity    P
2.   More vaginal depth         P
3.   Requires less dilation          P
4.   Requires less douching         P
5.   Requires less pre-op hair removal   P
6.   Less risk of prolapse         S
7.   May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology         S


24.   “less dilation” in 3 above does not mean “requiring dilation frequency is less”, it means “dilation is easier based on less pain” Is my understanding correct?

25.   in 6 above, the risk of vaginal prolapse is lower. Because the intestine is closer to the vaginal opening than the peritoneum?


At my first meeting with Dr. Gallagher she said the first urologist she was talking to had concerns that a PPV would not work on a male pelvis because it is narrow and deeper. Turns out this definitely won't stop good doctors.
So if they could not have pulled the peritoneal tissue down far enough safely, Dr. Gallagher can use a portion of penile skin for the outer entrance (introitus).

26.   As for the problem of male narrow pelvis,
the peritoneal tissue may be not able to be pulled down far enough safely. In such a case. penile skin or scrotal skin could be used. Is my understanding correct?


I'm at home now. It was a 4 hour car ride on just a doughnut cusion. I did take oxi for the ride home but oh how I dislike the comedown from that stuff. Back on just Tylenol.

27.   Is oxi a painkiller? Oxycodone (OxyContin)

Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 11, 2020, 06:26:39 am
Dear Josie,
Best regards,
Nozomi


Potential benefits of PPV (some updated according to the web of “Peritoneal Pull-Through Vaginoplasty - MTF Surgery”)
1.   Self-lubricating lining with some elasticity    P
2.   More vaginal depth         P
3.   Requires less dilation          P
4.   Requires less douching         SP
5.   Requires less pre-op hair removal   SP
6.   Less risk of prolapse         SP
7.   May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology         S



1. It definitely produces some internal moisture. This is very comparable to a cis woman's. This makes additional lube for dialation unneeded. However for penatrative sex to be comfortable I like any woman need to be turned on enough first so that my body releases fluid from the bulbourethral glands. The only difference is in a cis woman these have ducts that lead near both sides of the vaginal introitus where as in AMAB these are connected to the urethra. However its the same glands no matter which sex you were born with.

2. more depth than with penile inversion for certain. Colon may be able to have similar depth.

3. dialation has no pain inside the body. The only areas of potential pain is around the introitus and in relaxing the pelvic floor muscles. After healing I have had almost no pain or discomfort. However due to my lack of dialating for many weeks this year due to family issues and stress, I have had to work back up to the larger 2 dialators. The constriction occurs at the skin not the peritoneum.

4. I have not needed to douche in over 6 months. After surgery I was told to douche and shower daily. Then after so long just once a week. Now its not neccesary. The internal secretions make it "self cleaning" just slowly.

5. I had zero pre-op hair removal

6. There is no risk of prolapse when done in the Davydov style. This is because the vaginal lining remains part of the abdominal peritoneum tissue. One of the studies mentioned that the risk was eliminated with this method.
Other methods require tying the inverted penile skin or colon section to a pelvic ligament with surgical thread. If this thread tears the tissue or breaks the vaginal cavity can prolapse, or turn partly inside out of the body. With the Davydov, the vaginal tissue is connected directly to the abdominal pouch as it continues to be supplied blood through its existing vessels.

7. It is less risky than colon based method for certain. There is no need for a "bowl prep" or cleaning before surgery. There is no cutting of the bowl so no risk of sepsis from gut bacteria infecting the body cavity. There is no risk from rejoining the ends of the bowl together after cutting out a section for sigmoid colon method. The only risk of bowl issues would be the surgeon cutting the bowl while working inside. From what I've been told the robotic tools make this extremely unlikely. A skilled surgeon can avoid cutting the bowl even with the old hand operated laparoscopic tools.

8. I am adding this as an addendum to question 7. Smell: After surgery for a while I had a very strong odor of iodine. The packing they used at first was soaked in it. After that initial odor faded, my discharge had the odor of inner body fluid. This slowly changed and now I can admit the secretions smell like any woman would. Kinda gross thing to talk about but it seems an important observation.

26. This was a concern of some of the doctors evaluating the idea. However, AFAB with mullerian agenesis has a pouch in a similar low position inside the pelvis as AMAB. Generally in AMAB the pouch should go as low as just above behind the prostate.
However if this was an issue yes penile or scrotal skin could be used to connect to the peritoneum.

My pelvis is sort of half way between a "normal female" and "normal male". But from what I heard from the doctors during my follow ups, it didn't sound like the pelvis was an issue in the procedure.

I hope this meets site requirements?
(https://live.staticflickr.com/65535/50450479147_71b10501c9_c.jpg) (https://flic.kr/p/2jS8TMn)Comparison-of-male-and-female-anatomy-of-the-pelvis-Used-with-permission-of-Xochitl (https://flic.kr/p/2jS8TMn)

27. Yes oxicodone is an opiod based pain killer similar to hydrocodone
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 11, 2020, 04:07:45 pm
Thank you very much for your reply. 
espeecially,
23-3 "After healing I have had almost no pain or discomfort." & "The constriction occurs at the skin not the peritoneum."
23-4 Requieres less douching "SP" & "I have not needed to douche in over 6 months."
23-8 "now I can admit the secretions smell like any woman would."
and other explanation.

As for #26, the attached figure was very helpful for understanding.

I'm sorry, but I repeat the following two questions that are important to me.
In general maintaining one time per week now should keep everything fine for me now.

"one time per week" is similar to the frequncy of the dilation of Sigmoid Colon Vaginoplasty after one year.
24.“less dilation” in 3 above does not mean “requiring dilation frequency is less”, it means “dilation is easier based on less pain” Is my understanding correct?
23-3': Two acquaintances had Sigmoid Colon Vaginoplasty and told that postoperative dilation was extremely painful.
There are individual differences in pain.

"By avoiding the areas of potential pain, there is little pain in PPV dilation for everyone consistently after surgery.
while the dilation pain of Sigmoid Colon Vaginoplasty may be large for some time after surgery and may be relieved a year later."
Is my understanding correct? If not, please correct my understanding as much as possible.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 13, 2020, 06:38:17 am
Nozomi

"less dialation" first there is no internal pain from dialation. Simply a matter of the healing of skin around the introitus. Second, for now dialation once a week seems like a good practice if you are not having penetrative sex. Going for longer without only seems to be an issue if the peritoneum has not fully epthilized or for skin and external area concerns.

There is little pain with PPV. Again only the outer part where skin exists and healing still needs to happen.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 13, 2020, 03:21:37 pm
Thank you very much for your reply !!
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 20, 2020, 05:08:37 pm
Dear Josie,
2 weeks after surgery
Right now it seems it just means it will take longer to heal on the outside. I may have to deal with pain when dialating in that spot because what is called granulation tissue is often painful to touch until a new layer of skin grows across it.
I have to wonder that if I had not had dissolvable stitches if I might have been spared this external pain and only had the swelling underneath.

7 weeks after surgery: The last time of “granulation” in this forum before I ask.
So I saw Dr. Gallagher this week. Turns out everything is healing as expected. I have what seems like a big hump that is the opened urethra tissue that she kept for the vestibule floor. She said it often swells up that much and takes a long time but it will go down to a normal appearance in time. She had just one tiny spot she treated with silver nitrate for hyper granulation.

28.   As for granulation
28.1.   Has the granulation tissue healed?
28.2.   What has it changed to?
28.3.   When (how many weeks or months after surgery) did it heal?
28.4.   After that, did you need to avoid the part in the dilation?

I'm on the wait list for PriyaMed when the hospital there opens it up for regular use.

29.   Do you know how long the waiting time is? More than 1 year less than 2 years?
Best regards,
Nozomi 
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 21, 2020, 05:01:08 am
Dear Josie,
2 weeks after surgery
7 weeks after surgery: The last time of “granulation” in this forum before I ask.
28.   As for granulation
28.1.   Has the granulation tissue healed?
28.2.   What has it changed to?
28.3.   When (how many weeks or months after surgery) did it heal?
28.4.   After that, did you need to avoid the part in the dilation?

29.   Do you know how long the waiting time is? More than 1 year less than 2 years?
Best regards,
Nozomi 

28) granulation: When a wound opens to the air (such as when the skin pulls away from stitches exposing the underlying tissue) the exposed tissue will regenerate a new section of skin. While this happens there is rapid growth of nerves and blood vessels. This makes the area easily aggrivated by touch. It is painful to put any pressure on this new growth until a skin layer is done forming.

this happens when the wound is open. In my case there was some skin near the introitus and the skin flap around the lower outer radius cut of the surgery that "pulled" loose from the underlying tissue because the stitches fell out so quickly.
When a section of skin flap pulls away from the underlying tissue like this, that section of loose skin will die off as it separates from the blood supply it would be forming to the underlying tissue. This was not unexpected in general. Its a very common even in any such surgery. In my case had the stitches not dissolved so quickly I would have not had any significant amount of granulation to deal with.

I had some happen around the end of the urethral lining used as the floor of the vestibule. The tissue was swollen and the stitches dissolved leaving one small area that exposed enough to be treated. Otherwise I had one region at the vaginal introitus and around the lower incision that also had normal granulation. This made the start of dialation a bit painful but only while inserting the dialator. While simply holding the dialator in place it caused no extra pain.

28.1) Yes it all healed as expected.
28.2) The exposed surface heals into skin tissue.
28.3) Its been so long ago its hard to remember. I would say it had mostly healed closed by the 6-8 week timeframe.
28.4) No I never avoided it during dialation. There was a section of skin that had failed (pulled up and died off) at the introitus. When this happened it was painful just when the dialator was moving past the tissue. Lube was needed at this time as it helped keep the exposed tissue from dragging on the dialator. Once in place it caused no pain to keep the dialator there.

Granulation is very common in genital region surgery. With penial inversion and scrotal skin graft it can be very painful when it occurs inside the neovagina. Since my vaginal canal is peritoneum there is no issue with pain internally or the issue with failed skin grafts internally. Everything that caused me discomfort was external.

29) No I do not know what Pryamed's wait time is. I know from their FB posts that they stopped surgeries when COVID got bad in India. I haven't noticed if they have said anything about restarting. Most hospitals will do surgeries again. The schedule is just more spread out.

Where I went in Indianapolis, IN. USA they are doing surgeries. However IU Health University Hospital would require medical insurance to be able to pay for it there. At the time my spouse had insurance that covered GCS from her workplace. I had to pay a $300 facility fee and the second urologist who was in on my surgery (Dr. Roth) was not preapproved so I ended up paying his time fee of $800. The total bill from the hospital was over $80,000 but I think the insurance ended up paying close to $50,000. Without US type medical insurance it is too expensive to get done there. This makes places like Pryamed a more viable option as the costs for medical care and surgery at the hospital in Mumbai, India is so much less than in the US.

Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Jane.Shannon on October 21, 2020, 08:49:29 am
Josie,
Thank you for your detailed and thoughtful responses.  Like most detailed responses they create more questions.
I know one of the "cons" of PvP is that since the peritoneum is an internal organ it does not have touch sensation.  As your's has epthilized has it gained touch sensation?  Perviously, you mentioned you feel a pressure or "fullness" when something is inside you, has that sensation changed as you have healed?

I know cis vaginas have a decreasing amount of sensation as they go towards the cervix.  My thought would be to have the first 1 to 2 inches of the neo vagina made with skin (I am not sure which to be honest, but something sensate) and the remainder with peritoneal tissue.  This might give a little more sensation inside the neo vagina, while maintaining the benefits of using peritoneal tissue for the deeper internal structures.

Thanks,
Jane

PS.  As I wrote "inside you" I was thinking how thrilling it would be to say "inside me."  I am increasingly ready to get serious about GCS.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on October 21, 2020, 01:44:27 pm
28) granulation ...29)
Josie,

Thank you very much for your detailed reply!!

Thanks
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on October 21, 2020, 04:38:31 pm
Josie,
Thank you for your detailed and thoughtful responses.  Like most detailed responses they create more questions.
I know one of the "cons" of PvP is that since the peritoneum is an internal organ it does not have touch sensation.  As your's has epthilized has it gained touch sensation?  Perviously, you mentioned you feel a pressure or "fullness" when something is inside you, has that sensation changed as you have healed?

I know cis vaginas have a decreasing amount of sensation as they go towards the cervix.  My thought would be to have the first 1 to 2 inches of the neo vagina made with skin (I am not sure which to be honest, but something sensate) and the remainder with peritoneal tissue.  This might give a little more sensation inside the neo vagina, while maintaining the benefits of using peritoneal tissue for the deeper internal structures.

Thanks,
Jane

PS.  As I wrote "inside you" I was thinking how thrilling it would be to say "inside me."  I am increasingly ready to get serious about GCS.

Hi Jane.
To answer your question: The surface lining itself is not sensate. Cis vaginas are also not sensate on the surface of the lining tissue. What I feel is the pressure and internal sensations. I'm not quite sure how else to explain that part.  ;)
The feeling has changed in a way since right after surgery. Obviously the swelling is gone from the outer tissues. Oh boy was there swelling at first. Right after surgery and for some weeks after, the swelling of the lower perinial tissues added at least 2 inches to the amount of the dialator that was covered. So don't worry as it looks like you loose depth after surgery, It's just the swelling goes away.
I have an average depth (according to the internet) with a firm bottom. At least that's how I feel it.  :o

One of the pluses is that I never have to worry about vaginal prolapse from a torn suture like is possible with penial/scrotal skin inversion. My vagina also aligns with the center of my body. That was an issue with early penial inversion as the doctor had to tie the neovaginal skin to a pelvic tendon on one side of the sacrum/tailbone.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on November 02, 2020, 10:48:29 pm
Dear Josie,

I'm not in a hurry for your reply: After or before the presidential election vote doesn’t make any difference to me.

1. 
In Japanese hospitals that perform Davidoff surgery, a device called a prosthesis is inserted into the vagina for a certain period of time to prevent the vagina from narrowing (Please see the figures below).
If the prosthesis is in the vagina and it is difficult to defecate, you can remove the prosthesis from the vagina yourself only during defecation.
The prosthesis is also used in the paper "Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis”
Did you use a vaginal prosthesis?

(https://stat.blogskin.ameba.jp/blogskin_images/20201103/13/da/0P/p/o04090463nozomi543211604377185362.png)

(https://stat.blogskin.ameba.jp/blogskin_images/20201103/13/dc/IG/p/o05650621nozomi543211604377211100.png)

The shape from the tip in the 2002 paper, which could have been further improved.
(https://stat.blogskin.ameba.jp/blogskin_images/20201103/13/99/FV/p/o02040268nozomi543211604377233143.png)

A Japanese woman with vaginal hypoplasia wrote on her blog:
“I started using Atom Medical's vaginal prosthesis 20 years ago. I was 16 years old. One paper states that it will be retained at night, but I consulted from myself and started retaining it at bedtime a few years ago.”


2.
You can add me to the PPV list..
I’ll be having my surgery on the 9th November in Canberra, Australia with Dr Kieran Hart..
I’ll be the first or second in Au to have primary PPV surgery..

there’s also a number of girls in Australia booked in for surgery between November and February 2021.

Cheers
Angela

As far as I searched in Canberra Australia Dr Kieran Hart
I didn't know if his PPV is Davidoff-based surgery or not.
If you don’t mind, by asking Angela the right question to her post,
Would you please determine if his PPV is a Davidoff-based PPV surgery or not?

After your judgment
I will modify the table of Sept 20th in https://www.susans.org/forums/index.php/topic,243884.msg2388511.html#msg2388511.
In doing so, I will exclude Rachel Bluebond-Langner of NYU.

Best regards,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on November 03, 2020, 07:49:49 am
Dear Josie,

I'm not in a hurry for your reply: After or before the presidential election vote doesn’t make any difference to me.

1. 
In Japanese hospitals that perform Davidoff surgery, a device called a prosthesis is inserted into the vagina for a certain period of time to prevent the vagina from narrowing (Please see the figures below).
If the prosthesis is in the vagina and it is difficult to defecate, you can remove the prosthesis from the vagina yourself only during defecation.
The prosthesis is also used in the paper "Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis”
Did you use a vaginal prosthesis?



No they did not use a prosthesis. For the first week I had a standard catheter. Along with this I was to keep the surgical tape on with the dressing on the outside. This kept packing inside. The packing was surgical guaze soaked in iodine.
At my 1 week appointment the nurse removed the catheter, dressing, and packing. She then had me insert a dialator to make sure I could use it properly. I was to dialate daily at first after that and then cut down to once a week.
I lost some depth when family drama happened and I did not dialate for some time. In the early stages it was not uncommon for webbing like tissue to come out with the dialator. This is the self sealing property of the peritoneum. This is what the dialation is to prevent until epthilation occurs.
At first with the external swelling I am guessing depth was nearly 9 inches. As the swelling went down this decreased. Simply because the outer tissues were not swollen as much. After the swelling was gone I would say I had a good 7 inch depth. After I missed dialating last spring I lost some of that. I now still have an average normal depth around 10+ cm. The lack of dialating caused the deeper portions that had not epthilized to seal closed against itself. This was my mistake but life got in the way for a time.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on November 03, 2020, 03:00:12 pm
No they did not use a prosthesis.

Dear Josie,

Thank you very much for your reply in such a case.

Thanks,
Nozomi
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: AllieSF on November 03, 2020, 03:36:21 pm
Yes Josie,

Thank very much for this thread and your extra details pre and p[ost op and for answering all of Nozomi's questions, some of which I do not understand and others I get.  All this has been so informative and helpful to me as I am in the processing of deciding on minimal depth vulvoplasty or full depth with the peritoneal pull through.  If I go full depth it will be this, if not full depth that is another situation.  My issue is that I had my prostate removed in 2005 due to cancer (still clean 15 years later) and one doctor informed me that scar tissue from that surgery can be very difficult to deal with for the full depth version.  They don't know how good or bad till they get in there.  So, I am in the process of getting feedback from other possible surgeons.  My other problem is that very few of the doctors accept Medicare, except for Dr Maurice Garcia in the LA area at Cedars Sinai.

Thanks again.  You are a wonderful source of information,

Allie
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: josie76 on November 04, 2020, 07:24:37 am
Nozomi

"As far as I searched in Canberra Australia Dr Kieran Hart
I didn't know if his PPV is Davidoff-based surgery or not.
If you don’t mind, by asking Angela the right question to her post,
Would you please determine if his PPV is a Davidoff-based PPV surgery or not?"

Angela responded to my message and yes it sounds like the urologist Dr. Kieran is doing it as a laproscopic Davydov style. That is the best information as of now.




Yes Josie,

My issue is that I had my prostate removed in 2005 due to cancer (still clean 15 years later) and one doctor informed me that scar tissue from that surgery can be very difficult to deal with for the full depth version.  They don't know how good or bad till they get in there.  So, I am in the process of getting feedback from other possible surgeons.  My other problem is that very few of the doctors accept Medicare, except for Dr Maurice Garcia in the LA area at Cedars Sinai.

Allie

Allie, I can only go by what my surgeons said. According to Dr. Koch ( the Dept Urology Chair at IU Health University Hospital) such things would not have any effect on this procedure. He also said no problems with the hernia repair and metal staples I had in my lower abdomen.
Title: Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
Post by: Nozomi on November 05, 2020, 02:34:53 pm
Nozomi
Angela responded to my message and yes it sounds like the urologist Dr. Kieran is doing it as a laproscopic Davydov style. That is the best information as of now.
Dear Josie,

Thank you very much for your confirmation and reply !

Thanks !
Nozomi