I had Secondary Sigmoid Colon SRS with PAI

[M. Sharon]

M.Sharon - good luck with your upcoming surgery.  I am also planning secondary sigmoid srs with Dr Sutin soon. I look forward to hear your story and experience 🙂

Spiral - thank you so much for sharing ur experience!! I had my first SRS with Suporn in 2003. After 16 years, I lost 1/2 or 1/3 of my depth and needing an upgrade.  Ur story giving me so much hope for a secondary srs. ❤️

Hi Lala girl, thank you for kind message. I guess you are the one who sent pm to me asking about prices and accommodation and waiting time. I tried to respond through pm but unfortunately failed attempt, hence, i will post it here.

Hi Aisla, I was quoted $15,000 for secondary colon srs it includes labiaplasty as i got some unacceptable appearance at vulva floor from my first SRS back at 2005. I ended up with 3.5 inches though I primarily got 5 inches in my early post op with skin graft. BA is quoted $5000 for 450c cohesive silicon gel, high profile, mentor brand, smooth surface.

I waited 3 months since first consultation and I was asked to have BMI 23 for my height 5'8".

I am staying at a good service room near PAI and will be staying here for 1 month post operative recovery. hospitalizing will be 6 days after surgery so total of 35 days post surgery stay in bangkok for my adequate recovery period.

The room I rent is 26 m.sq space which is just enough for single person stay with favourable n affordable 25000 Thai Baht by monthly plan without breakfast. Colon surgery won't make you eat most of foods except congee n soft diet that missing breakfast is not a thing to loose for. Some juice, yogurt and soft diets are only your regimented foods to eat after colon surgery. Today I went through pre medical check up at Payathai hospital and just got back to room now.

Don't hesitate to ask more q dear.

Best regards, M.Sharon

[LaLa_girl]

M.sharon - thx so much for the information. I was quoted the same but I am not changing the external as I love the result Suporn gave me.  It looks and function well.  Based on Spiral review, they didn't damage or add new scars to her external...so that's exactly what I want.  My most corcern is the scar....like how noticeable would that look.. I google for c section scars and saw some are pretty bad.. kinda make me nervous

[Linde]

M.sharon - thx so much for the information. I was quoted the same but I am not changing the external as I love the result Suporn gave me.  It looks and function well.  Based on Spiral review, they didn't damage or add new scars to her external...so that's exactly what I want.  My most corcern is the scar....like how noticeable would that look.. I google for c section scars and saw some are pretty bad.. kinda make me nervous

Any scar quality varies from surgeon to surgeon, and also how concerned they are to leave a nice looking scar behind.  Some can create scars that are hardly visible, others create big red welts for the identical surgery.

[AnonyMs]

I believe age and ethnicity also influence scarring.

[Linde]

I believe age and ethnicity also influence scarring.

Not really, age may influence healing a little, but certainly not scaring, and ethnicity should not have anything to do with it, because a surgeon can adjust for all kinds o different skins.

[AnonyMs]

Not really, age may influence healing a little, but certainly not scaring, and ethnicity should not have anything to do with it, because a surgeon can adjust for all kinds o different skins.

I've heard it from surgeons and doctors before, but I looked up a few references. Its good news for me for a change.

Overview of Surgical Scar Prevention and Management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055805/

• Aging tends to decrease skin tension and sebaceous gland activity, and as such, hypertrophic scars are observed with lesser frequency in the elderly. This is in contrast to incisional scars in children, among whom hypertrophic scars are common because of increased cellular activity, prolonged scar maturation, rapid physical growth, and increased skin elasticity.
• Additionally, ethnic skin characteristics and their association to postoperative scar response have been well documented. People of European descent are more likely to form fine scars, while people of African descent appear genetically predisposed to hypertrophic scars and keloids.

Keloids: Pathogenesis, Clinical Features, and Management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884925/

• Although keloids have been documented in virtually all major ethnic groups, they are most commonly seen in individuals of African, Asian, and, to a lesser degree, Hispanic and Mediterranean descent
  
• Although keloids can occur at any age, they are most likely to occur between the ages of 11 and 30 years.

Being older helps skin heal with less scarring
http://www.dermatologytimes.com/wound-healing/being-older-helps-skin-heal-less-scarring

• Older skin might heal more slowly, but it heals with less scarring than younger skin.

[Linde]

As I said, surgeons are able to adjust for those differences, and can decide whether to close a wound with sutures, staples, Steri Strips or skin adhesives.  Sutures are the way cheapest method for wound closing, and also do not require to learn a new wound closing technique.  That is the reason they are used most of the time.  Steri Strips and skin adhesives are providing the cleanest looking scars, but are more expensive and requiring a certain know how for the application.  some surgeons may not have this know how.
Once the scar is healed (wound is closed), scar massaging can reduce a lot of ugly looking scars, and make most scars looking pretty good.

[SpiralCream]

Spiral - how's your scar doing? Are u able to exercise (weights or running) yet? Would it be possible to see a pic of your scar? I am most likely will have the secondary sigmoid srs with Dr Sutin in March.  I'm excited but also nervous.  Dr. Kamol confirmed he does laparoscopic technique that can give the same depth as open.. however, I couldn't find much information from other ppl experience so I don't want to take that chance.  PAI price also increases a lot from previous year....do you mind msg me about ur price?  Thx

Sorry I am not comfortable publicly posting pictures of my scars.  But another trans woman did.  If you go to the review website RealSelf, a woman posted her post-op pictures of her colonvaginoplasty with Dr Sutin at PAI in 2017.  In that review, you can see her pictures of the abdominal scar.  I can say from my own experience that my scar looks exactly the same in location and size.  My surgery was with Dr Burin, but I am pretty sure that neither Dr Sutin nor Dr Burin make the abdominal incision.  There is another surgeon at the hospital (the colon surgery specialist) that does the abdominal scar incision and stitiching.

I am able to do every exercise now, but I am not pushing myself.  I think after 2 months I felt like I could do anything physically.  But I am a pretty slow healer overall, so I bet most other people could begin exercising sooner.

[M. Sharon]

I am not going to write a new post as I'd like to fill or add up additional info here based on my own story with PAI. Well, it's 3 days post operative from my secondary colon srs with Dr.Sutin from PAI. Everything went well and most intense pain I had past 2 days are almost gone. Only mild tolerate pain at 3 surgical sites persist which are at BA, my C section cut at lower abdominal, and genital Vulva.

I admitted in Payathai 2 hospital before midnight the surgical date. The hospital rooms are big, medical amenities modern and nurses are very active wearing smile day and night. I slept there overnight and early morning around 6, two nurses work me up to enema for bowel flushing . Each time it was 1 litre of saline water and total of 3 and it was easy on me.

There were 3 surgeons involved in my operation Dr. Sutin, the colon surgeon, his assistant, and anesthesia's. It took 6 hrs for secondary colon srs, genitalia repair, and BA.

The pain I had from 0-10   was 7-8 in the following day 1 and 6-7 on post second day. Today I think it is 4-5 moderate pain I got but I am still on morphine. Dr.Sutin visits everyday to check things are under control and he remove my BA blood drainage today as it is no more needed. He encourage me to walk slowly to get gas pass to motivate colon gotten back to work. He asked whether I fart yesterday but this morning when he visit I had non yet. Now I fart 3 times lying in bed and let him know that I am allowed to sip water a little by a time just enough to quench. I was not allowed anything by mouth (NPO) for total of 3 days since the surgery.

Dr.Sutin at PAI is, to me probably the best surgeon in the world especially on colon srs , as he can find out and fix my long term urine inconvenience problem after I had it in my first srs with Dr.Pichet in Bangkok a long time ago.

I was always in the great problem with urine dripping by every night while asleep and had to wear diaper  like a little child. I was so shocking and let Dr. Pichet know as soon as It happened to me in my early post operative days and just got respond "I might cut your urethra too short and it seems irreversible, it is a kind of common complication, but there is one medicine name Tofrail (Imipramine) that can be bought on counter". Killed my hope to seek to other surgeon for alternative treatment, by that time, as i thought he know the most what he did to me. Since then I always carrying diaper wherever I travel. Furthermore, My vulva area has ended up with unacceptable appearance and orgasm is lost ever since.

Yesterday Dr. Sutin mentioned I had urinary fistula in my vagina that is probably the cause of my dripping problem and he said he has closed it now.

Could not be happier to hear it as I really really do believe this was a root cause of peeing in bed, to me, it can be as compare to a lost-son- found that my happiness was beyond words, it has just now been solved and thanked to Dr.Sutin for being able to troubleshoot accurately. His competence in surgical skill at this point was very impressive already though his new works were not unpack yet.
At the same time I insisted that I will never go to Dr.Pichet even for a minor acne treatment again.  He did this thing to me and he did not know what's wrong with me till a qualified surgeon like Dr.Sutin could sort it out after many years. All the things he had done on me had to repair : depth, vagina, urethra, etc.

I hope when I healed up this operation my night time urine dripping problem would be solved.

I will write later ...

[M. Sharon]

4th days post operative

- vaginal bundle is removed
-Dr. Sutin allowed to start drink and clear broth as I get gas pass.
-mild fever since day 1 post-op around 37 and I am told this is normal.
-every 45 min nurses come and check such as IV, BP, urine, blood drainage, antibiotic.
-I start to walk in the room for a few min and not bad.
-all blood drainage are removed breast & vagina
-the bandage ties with implants and chest brutally so tight that make me most discomfort. hardly breathe in but no pain now.

[LaLa_girl]

Sharon - congrats! You did it! And thank you for sharing us your experience.  I am in the process to finalize my booking with Dr Sutin for my secondary sigmoid srs.  I hope you have a speedy recovery and can't wait to see more of ur post

[M. Sharon]

Sharon - congrats! You did it! And thank you for sharing us your experience.  I am in the process to finalize my booking with Dr Sutin for my secondary sigmoid srs.  I hope you have a speedy recovery and can't wait to see more of ur post

Thank you Lala_girl for kind words, I am now 5th days postop and getting better each day in terms of pain, fever,apetite etc. You are in good hands with PAI either you choose Dr.Sutin or Burin as they are efficiently well trained by Dr Preecha. The colon surgeon they use is such a good lecturer of Royal Thai universities majoring this subject especially for your safety. The whole team is of top surgeons in their respective fields. For my personal advise, please quit smoke at least 2 months prior surgery if you are a smoker. Do lots of physical exercise as early as you can such as running on treadmill it really pays off for me now.  stop hormones, steroid and Vit E 2 months prior and eat well balance foods. As these are so important to prevent a deadly complication like "anastomotic leakage" (mostly happen 3%) the leak at sigmoid colon where two colons are joined but it is extremely scary complication rather than kinds of other wound Infections. I am going to stay in hospital as my senior sister "sprialcream" did because 80% (more than 2% out of 3%) of colon leakage happens in this very first week and I needed to be sure I discharge hospital without it. The rest 20% possibility is to take care by myself for the rest 1 month postop. Meaning we should not eat whatever we want in that sensitive time frame to keep us safe from such worst case scenario. I will keep update.

[LaLa_girl]

Sharon,

Great information, thx for all the tips.  Leakage would be my most concern as well, but I don't think there are of those cases.  I have been working hard on my fitness as well.. lots of gym time and sports. I'm about 5'6 and 138 at the moment and Dr told me not to gain any more weight. How would u rate the abdominal incision pain compared to boobs? I can't wait to hear ur first dilation experience....have a speedy recovery! If you are still in BBK around mid March.. we should definitely link up!

[LaLa_girl]

Surgery booked for 3/19 with Dr Sutin.  Nervous to go through this procedure again but also excited to have a functional vagina and getting my sex life back. I am getting the secondary sigmoid srs, which only regain my lost depths.  Nothing will be changed externally as dr Suporn gave me a beautiful looking vagina 16 years ago.

[LaLa_girl]

Spiral and Sharon! I hope ur recovery is going well. Any updates? Hope to hear from both of u soon. ❤️

[M. Sharon]

Spiral and Sharon! I hope ur recovery is going well. Any updates? Hope to hear from both of u soon. ❤️

A lot has happened since I discharged from hospital 2 weeks ago. Firstly, on the 7th day when I was preparing to discharge from hospital though i intended to stay one more night in hospital but I think i was ok to go back hotel despite not being strong enough yet but just enough to move a short walk. Staying extra night will cost me around 11000 Thai baht (approx 330 USD) which is alot of money for me just to sleep one night there. By that time, all IV line and morphine are removed since 2 night before already and all the care the nurses providing were hourly BP, blood oxygen and urine disposal from catheter bag and giving medicine twice a day, that's all, that I determined I need no intensive care to have to pay extra stay for. But if you could extend your stay and could afford 300+ USD / night it really the better for you to have adequate rest. I do recommend it if you travel alone. A wheel chair is arranged all the way from my hospital room 22nd floor of Pyarathai 2 to the door of awaiting PAI car. A big thing happened just before I get out of room I stand up and collected my personal belongings by aid of nurses and sip a water, a lot of blood poured out into my pad as if all the water i just drink instantly drain out of my vagina but I know it's not possible to be water to come out of vagina that i looked down to check in my pad i neatly wore. Bloods were red dark color as much as 70-80 ml I think that the whole heavy duty pads sank wet and it even could not absorb and able to hold all leakages that blood also wet my pant . I was so scared immediately and nurses were rush reaching for me holding my hands put me back on the bed to lie down. Nurse were calling to surgeon to express what was going on with me by phone. I did not suffered any pain down there nor have fever that i realized it can't be kind of anastomotic leak which I afraid the most to happen throughout in my first week,  I then instantly could figure out about this dark blood leaking from what i've learned from earlier Spiralcream posts that really made me relax in mind to certain degree. Thanked to Spiralcream for all the detail information provided as it played a vital role as a full guide in my surgery. The nurse then asked me to lies on bed by side and to watch for another 15 min if blood still coming out or not. Fortunately it was non, no more blood from vagina that I was let to proceed to discharge from hospital same evening by the instruction of my surgeon to attend nurse through phone. So i could assure it must not a big deal. Of course, what Spiralcream experienced about dark red blood clot by her 2.5 week post op has happened on me exactly at 1 week post.  I sit on donut given by hospital and the foley catheter was still in place that I put the urine bag on the floor. I was kinda of too discomfort with certain amount of tiredness when I arrived hotel. It was the only one complication so far till 3 weeks post op now and everything went very smoothly well. today is 3rd appointment (final) at PAI having got checked with Dr.Sutin and learned everything is healing fine and so well that I was allowed to fly back home. However I will be here a few more weeks and doctor to check another final exam before i fly back home as I have 3 surgical sites, colon-vaginoplasty, vulva reconstruction, urethra fistula closure. I will get back with more important details and recovery tips shortly how things i went through past 2 weeks since i get back to hotel.

[LaLa_girl]

Sharon,

I am glad everything is fine with your recovery and hope it gets better each day.  I am definitely taking notes on this one as I know I will freak out if I see lots of blood.  How's dilation so far? Easier and less painful? I will head out to Thailand exactly 3 weeks from today and my surgery is on the 19. At this point, I'm only going to have secondary sigmoid to fix my lost depth. There might be a chance dr Sutin will do fat transfer on my vulva to have the vagina less of a gapping .  Mine doesn't look too bad but when I spread my legs, I feel like my vagina opens a little bit haha .  Can't wait to hear more of ur experience because you are really helping me to prepare for my upcoming surgery ❤️

[M. Sharon]

There were 4 pre consultation sessions I have had at PAI before my colon vag and BA. 1 with Dr preecha and 3 with Dr Sutin. Brief discussion points and my personal concerns and their answers were as follow:

BA : Both surgeons recommend Smooth surface silicon gel implants as it has very less report of possible (rare but possible) BIA-ALC cancer (auto immune cancer) compare to texture surface according to FDA and their research and I agreed I would go smooth surface after I also find out that info on internet 1:4000 to 1:30000+ possibility of ALC with textured surface on FDA website. I choose 500 cc high profile smooth mentor silicon gel as I have moderate wide of chest and 173 cm height (approx 5'8").

Urine leakage: I had that problem for more than one decade affecting my quality of life as I had to wear diaper by night time to manage this dripping. By day time I seems to be able to control my bladder but some pee spot in my panties when rush to bathroom but not a big deal. Dr Sutin stated this thing can't be done and cannot guarantee to solve as there are 2-3 factors causing urine to leakage I had in my previous srs surgery with Dr. Pichet that he may not be able to locate what wrong with me exactly. He insisted he would try his best finding cause but cannot guarantee at all.

Vulua reconstruction: I have unacceptable vulva floor no labia minor and proper shape of clitoris and pretty wide open vagina introitus that looks so ugly. Dr. Sutin will fix this cosmetic reconstruction.

Orgasm : I never ever have orgasm ever since my first srs surgery back at 2005 and asked Dr Sutin if he can manage to solve this thing and he cannot guarantee saying I might ended up with damaging important nerve in my previous surgery that he can't fix it.

vagina depth: I asked I'd like to have 8" depth after colon srs. Dr sutin said Colon graft has elasticity and suggest he would spare 1.5 to 2 inch skin at entry and join colon at that point cutting 6 " to have around 8" and I can accommodate any 8" penetration. To me, it sounds that he seems suggesting me not to too greedy on depth to be cutting off as much as 8" long colon graft net while 6-7" colon can be expected to easily accommodate any 7-8" penetration. I thus convinced it must have come up with some drawback laid behind for having cut 8" or more of colon length in terms of possible higher risks of excessive mucous discharge or bleeding or something  that I agreed 7" to be my total vaginal depth post op. And I assumed very single inch cutting more of colon length may make higher chances of longer irregular bowel movement to my understanding. While Average cis woman depth was 5" plus some extent of elasticity to adequate sex and mine having got 7" plus similar elasticity is quite acceptable that I confirmed mine to be 7".

I will write up more about post op results, dilation, dealing with bowel movement, catheter and pain shortly.

[M. Sharon]

https://www.realself.com/review/mtf-vaginoplasty-secondary-colon-srs-drsutin-pai

this is me (above link)  on Realself with colon neo vagina photos if somebody wonder.

[M. Sharon]

Colon srs recovery was very hard for me though i did not had any major complication. For the first two day since I wake from anesthesia, I suffered intense pain and great discomfort at breast implants, reconstructed vulva area and great soreness at lower part bowel area that i even can't correctly locate which part got how much pain the most. Morphine and IV line are continuously given for five days in hospital. Nurses were very caring and hospital room was very big and comfy. There was another bed in the room if someone accompany with me. The breast pain was intense that I felt like regret to choose big 500cc HP implant on me and thought I should have been going 425cc which may make less tightness n pain in my chest. I even got another regret to have this colon srs in the first week. Can't stop thinking and blaming myself for going this surgery as big mistake just because of wanting to get back sex life which is unworthy to risk with tons of bowel health and possible big complications I may have to deal for the rest of my life. I even cried alone in my hospital room. After I got back hotel, my foley catheter is still in place for another week to let fistula healing up. On day 8 postop, I was picked from hotel to PAI where Dr.Sutin teach how to dilate, he insert #1 dilator in the examination room and it was like slaughter, I shout aloud from pain when dilator pass colon-skin joint but Dr. Sutin won't give up and finally it reached its desired depth to 5" and I was asked not to go beyond 5" to let inside colon part to heal for 2 months. It was the worse pain i ever got in my colon srs that can't be control by any sort of pain killer.  It really hurt to dilate for another 2 days in hotel to reach 4-5" but it get abit easier each day from 3rd day onwards. After 2 week Dr Sutin removed catheter and checked if my urethra heal up well and checked everything and said I am in good healing process. I stll not poo till my 12 days postop. I was in strong feeling of poop but could not stain due to foley catheter in place. It was big distressing and made me big concern for unknown status of unpredictable up coming poo, pee, and fistula healing condition. I was very unhappy with all discomfort not only physically but also emotionally. I was on antibiotic for 3 weeks for 3 surgical sites and I did not need to take paracetamol since i discharge from hospital. Pain was only at first 2 dilation sessions and I did not had big wound pain that I stopped taking pain control med starting from 6 th days when i was in hospital so far. The thoughts of regret about colon srs fade away after 3 weeks postop when I am enough recover to fly back home and yes improve self confident in mind that I can have sex with any guy successfully which was limited and ever opted out in my life before. Wow changed in mind I did the right thing, praised myself and praised the Lord. Of course I say many prayers many times a day in my early weeks ,of course, it surgery will also draw you closer to Lord as it has a lot to concern.

Dilation : First 4 sessions were really hurt, but on 3rd day the dilation pain is getting better and relief significantly. But still discomfort when dilator nose pass colon-skill joint inside untill 2 weeks. But each time it gets easier though. Now I am 26 days post and having pain free dilation. I dilate twice a day n each session I put it 45 min although I was asked to do it 30 min for each session.

Mucus discharge: It comes usually within 30 min after each dilation session with some blood trace in it. But from 2nd week it subside significantly with lesser blood content in it. After 3rd week it come out very small amount only after dilation session it clear like water gel odorless and now it is as few as amount of mucus you spit out lung mucus when you cough. I am pleasantly surprised by this.

Pain : I do not have particular pain that make me hard to bear. Hence, I stopped paracetamol since i get back to hotel. But there are some sting n soreness at vulva where Dr.Sutin created Labia minora and new clitoris hood and at discomfort urethra and bladder swelling while peeing due to 2 weeks dwell of catheter. The incision at bowel muscle cut is a source of discomfort but numbness is more accurate to express than to say it pain.

UTI: today is 26 days post op and I have UTI this morning, I have Augmentin (Amoxicillin trihydrate plus potassium antibiotic) ready in my room that I started to take it, it's Sunday here and PAI closed. But I informed Jessie (patient coordinator) about it and got reply he will forward message and doctor's management tomorrow morning. I expected this UTI to happen learned from Spirelcream and many other former colovaginoplasty patients. Almost all girl experience UTI in their 4 weeks to 6 weeks postop. I also had UTI back at home once or twice in a year and E.coli was always reason for UTI and urine culture resulted to be treated with Amoxicillin that I bought Augmentin beforehand. This med can be bought at any pharmacy in Bangkok without prescription. I had to go toilet several time for pee with some soreness at bladder while urinating. Now I feel like normal and symptoms go away even with 1 pill. I have to go another 4 days for full dose. I have no fever nor blood in urine but a little feeling of chilling this morning.

Bowel movement and poo : I had my first poo 12 days postop. It was very difficult to strain poo for me as catheter is in place and cannot able to squeeze bladder for pee resulted in unable to poo though i have strong feeling of poop. Very difficult time for me trying to poo with catheter throughout 2 week. Only very little amount of poo come at a time thus I ever dare not to eat soft diets foods much worrying if i make more poo in bowel and getting more trouble. Another concern is i was afraid to give strong pressure on bowel movement concerning if my anastomotic suture could be tear or leak. So I drink Ensure liquid diet throughout 2 weeks to minimize poo accummulation in my guts. Very little poo I made were normal poo like 1" solid poo but not too hard to be constipation. And yes it was weird to have both feeling of hiarrhea and constipation at the same time. Now affter 3'weeks when i eat enough (but only boiled rice, some soft bread, half boiled eggs and Ensure drinks) are still my daily meals so far, that I poo much and better and only 4 to 5 times a day I need to go to bathroom to make small poo at a time but poo are normal poo. So it can be said that my Bowel movement is slowly getting back to normal within fourth weeks. At the moment,  have no idea if i eat heavy meals like before and how my colon would respond it but i have to introduce little by little next weeks. I'm also waiting how bowel movement goes with Spiralcream to learn here to take some necessary precaution.

I will add up info here in this post soon enough. I am sorry about my English as I am not English native speaker but I hope you guys can understand.