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Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review.
Shah, Viraj; Hassan, Bashar; Hassan, Rena; Alexis, Malory; Bhoopalam, Myan; Agandi, Lorreen; Liang, Fan.
Affiliation
  • Shah V; Faculty of Medicine, Imperial College London, London SW10 9NH, UK.
  • Hassan B; Johns Hopkins Medicine, Baltimore, MD 21287, USA.
  • Hassan R; Department of Plastic and Reconstructive Surgery, Center for Transgender and Gender Expansive Health, Johns Hopkins Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
  • Alexis M; Faculty of Medicine, Saint Georges University of Beirut, Beirut 2807, Lebanon.
  • Bhoopalam M; Florida State University College of Medicine, Tallahassee, FL 32301, USA.
  • Agandi L; Johns Hopkins Medicine, Baltimore, MD 21287, USA.
  • Liang F; Touro College of Osteopathic Medicine, New York, NY 10027, USA.
J Clin Med ; 13(12)2024 Jun 19.
Article in En | MEDLINE | ID: mdl-38930109
ABSTRACT

Objectives:

Fewer than one-fifth of all studies on gender-affirming care originate from low- and middle-income countries (LMICs). This is the first systematic review to examine surgical demographics and outcomes following gender-affirming surgery (GAS) in LMICs.

Methods:

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were systematically searched for original studies and case series on GAS within LMIC settings. Excluded reports included animal studies, non-English language studies, secondary studies including reviews, individual case reports and conference abstracts.

Results:

This review includes 34 studies involving n = 5064 TGNB individuals. Most studies (22, 64.7%) were from upper-middle-income countries, followed by lower-middle-income countries (12, 35.3%). A total of 31 studies (91.2%) reported on post-operative outcomes. Of n = 5013 patients who underwent GAS, 71.5% (n = 3584) underwent masculinizing and 29.5% (n = 1480) underwent feminizing procedures. The predominant procedures were metoidioplasty (n = 2270/3584, 63.3%) and vaginoplasty (n = 1103/1480, 74.5%). Mean follow-up was 47.7 months. In patients who underwent metoidioplasty, 6.8% (n = 155) of patients experienced a complication and 6.3% (n = 144) underwent revision surgery. In patients who underwent vaginoplasty, 11.5% (n = 127) of patients experienced a complication and 8.5% (n = 94) underwent revision surgery. Of the studies (25/34, 73.5%) that reported on quality of life and post-operative satisfaction, the majority showed marked improvements in psychosocial and functional outcomes. Notably, no post-surgical regret was reported among the surveyed patients.

Conclusions:

Existing literature on GAS in LMICs remains scarce and is concentrated in select institutions that drive specific procedures. Our review highlights the low reported volumes of GAS, variability in surgical outcomes and quality of life.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Med Year: 2024 Document type: Article Affiliation country: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Med Year: 2024 Document type: Article Affiliation country: United kingdom