Dr. Narender Kaushik was very unpleased with all available surgical procedures for MtF transgender patients. The only surgical procedure that to him was promising enough to reach great results in every aspect of what Dr. Kaushik saw as mandatory for a good GCS/SRS procedure, was the sigmoid colon approach, that still had a few quirks that definitely wanted improvement.
In long hours of evaluation and progressive approach considerations, Dr. Narender Kaushik’s efforts finally resulted in the best GCS/SRS procedure available today – his OLMEC SIGMA-LEAD GCS/SRS.
It is solely and exclusively practiced by Dr. Narender Kaushik here at OLMEC HEALTHCARE, the Premier Transgender Surgery Institute, in Delhi, India and has become the gold standard for MtF genital reassignment surgery.
The hallmark of his technique is something one would never expect from a surgery like this:
The MtF patient will usually have a painless and woundless recovery which progresses very fast and with minimal post-op aftercare
The OLMEC SIGMA-LEAD GCS/SRS consists of 2 steps which will be performed right after each other. In the first step, the vulva – the external female genitalia – will be created. In the second step, the highly refined and improved rectosigmoid colon vaginoplasty will be performed.
Step 1 of the OLMEC SIGMA-LEAD GCS/SRS consists in creating external female genitalia that look as natural as possible. You will have labia majora, labia minora, a clitoral hood and a clitoris. The clitoris and the labia minora will be fully sensate and arousable.
Our surgical procedures are performed with utmost care and precision. We use local anesthesia to complement your general anesthesia and to help in tissue preparation and bleeding management, resulting in less general anesthesia for you because our procedures can be performed in a better way. However, we always take the greatest care to ensure maximum tissue vascularity (blood supply to the tissue) to achieve the best possible results.
We will use all available genital fat and other proper tissue to ensure beautifully defined and full labia majora.
We will shorten your urethra to proper female length and position.
We will perform an orchiectomy (removal of the testes) and we will remove all unnecessary muscle tissue and the spongy tissue of your penis (corpus cavernosum and corpus spongiosum) carefully. We always take the greatest care to keep your urethra and the nerve and blood supply to your glans penis intact.
We will deglove your penile skin – which means we take the outer skin off your penis body. With this tissue, we create your clitoral hood and your labia minora.
The tip of your penis – called the glans – gets reduced in size to create a proper clitoris (clitoroplasty).
Along with its highly sensitive and important nerve bundle and its blood supply, the clitoris then gets repositioned at the proper location just beneath the clitoral hood.
The urethra – shortened to proper length – will be repositioned (urethroplasty) and the tissue for the labia minora and majora (labiaplasty) will get positioned and sutured to settle down in their final new home.
A penile skin tissue flap will be left over towards the vaginal entrance to later be the lining of the first 1-3 inches of the vagina measured from the beginning of the vaginal entrance. This step is extremely important because it will hide the red mucosa of the colon transplant and it will prevent ring scar contraction at the vaginal entrance.
Step 2 will now create a fully sensational and self-lubricating vagina by using the rectosigmoid colon transplant.
A 5-7 inches (13-17 cm ) incision is made in the left groin and the sigmoid colon is then being inspected for the blood supply vessels, to decide wich part is the one that wants to be harvested and used.
We only use a small about 15-22 cm long rectosigmoid colon part of the bowel, because it has only mild secretions which settle down over a period of about 6 months.
The colon gets separated.
In spite of your bowel cleanse preparations, we will perform an intraoperative bowel wash of your open colon segments before we move on with the surgery. These extra 5 minutes of this precautionary measure has gained us a wound infection rate of about zero.
Then we take out the rectosigmoid colon transplant, which gets closed on one side, which makes for the end of the vagina.
The separated sigmoid colon bowel parts get joined again (anastomosis).
The vaginal cavity gets created which reaches from above your anus all the way to the rectosigmoid colon graft, passing underneath the urinary bladder. Once the cavity is opened up all the way the rectosigmoid colon graft gets inserted through this cavity.
The penile skin which got prepared for the vaginal opening gets sutured to the rectosigmoid colon graft in a star-shaped manner, which avoids ring star contraction at this suture.
The rectosigmoid colon gets fixed in its position inside your belly and the groin incision is closed by layer technique, to ensure minimal scarring and to completely avoid adhesions of tissues involved.
After surgery, you will wake up with a dressing in your genital area and on your groin. Both of these dressings are painless. The groin dressing will be removed after 2-3 days.
For the next 4-5 days, you will be on IV (intravenous ) medications, which are antibiotics and pain killers. Also, you will have an epidural which reduced general anesthesia use during surgery and besided the pain killers the epidural is now highly effective for pain management.
After 2-3 days you will usually be allowed to take in liquids again, depending on when wind begins to pass through your anus.
The catheter will be removed after 6 to 7 days. Also after 6-7 days you will start walking again.
Dilation will be started 5-7 days after surgery. Dr. Kaushik will instruct you on how to do dilation properly and you will learn it fast.
You have to maintain local hygiene, which consists of washing your genitalia with a betadine mix (water and betadine solution) for about 3 weeks.
It will also be required that you wear a sanitary pad for the initial few weeks after surgery until discharge becomes less.
Sexual activity usually can be resumed after 1 ½ – 2 months.
The usual hospital stay for Indian clients is 7 to 10 days.
For overseas patients, a stay of three weeks is recommended to ensure complete recovery under Dr. Kaushik’s personal supervision before departure.
Any minor touch up procedure – should it be needed – will be done during this time period, so you can have a relaxed and worry-free departure.
You can find the Dilation Instructions after OLMEC SIGMA-LEAD GCS/SRS.