Chennai, November 25, 2025:
In a first for Tamil Nadu, SRM Prime Hospital successfully used a bovine pericardial patch to close a neovaginal fistula — an abnormal connection between the rectum and neovagina — in a 22-year-old transgender patient who had previously undergone male-to-female gender-affirming surgery elsewhere.
The condition had caused the passage of flatus and faecal matter through the neovagina. The minimally invasive endoscopic day-care procedure helped the patient avoid major open-abdominal surgery and prolonged hospitalization.
The procedure was performed by Dr. Arulprakash S., Clinical Lead and Senior Consultant, and Dr. Tarun J. George, Senior Consultant – Medical Gastroenterology and Hepatology, under the guidance of Dr. C. Paul Dilip Kumar, Director – Medical Services, SRM Prime Hospital.
According to Dr. Arulprakash, recto-neovaginal fistulas are rare complications occurring in nearly 1% of gender-affirming surgeries. Earlier treatment attempts elsewhere using endoscopic clipping provided only temporary relief, making this a rare and challenging clinical situation.
The SRM Prime Hospital team opted for an advanced endoscopic closure using a bovine pericardial patch — the first such procedure performed in Tamil Nadu. The biological patch acted as a scaffold to support tissue healing and close the fistula without open surgery.
The complex procedure involved two endoscopists working simultaneously from both sides of the fistula tract to position and secure the patch using a 14 mm over-the-scope clip.
Dr. Tarun J. George explained that the team performed a contrast CT scan to assess the fistula before proceeding with argon plasma coagulation to prepare the tissue surface. The bovine pericardial patch was then placed and secured successfully using the clip system.
The patient was discharged on the same day and advised one week of rest, short-term antibiotics, and stool softeners during recovery.
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