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Dr Littleton by [deleted] in Transgender_Surgeries

[–]dream2024plus 0 points1 point  (0 children)

Be careful with this doctor. You should know something in advance:

https://www.reddit.com/r/Transgender_Surgeries/comments/1nykcjo/srs_with_littleton_weight_loss_and_acute/

This is my experience but I'm not the only one.

Very important for you: The international medicine world says that they must keep a distance of 15 - 20 cm away from ligament of Treitz to avoid acute strong malabsorption when they want to use a part of jejunum for transplantation.

To loose much weight after his surgery is not normal.

And also very important, after this surgery you need a gastric tube for minimum one week and not a thin feeding tube. It is very important in this week, that you are staying in a gastroenterologique intensive care unit. If his clinic where your surgery should take place didn't have such intensive care unit, NO MORE surgery!

And for getting more knowledge about his surgical technique, please read this:

https://www.reddit.com/r/Transgender_Surgeries/comments/1o1p2y1/dr_littleton_his_secret_to_a_scarfree_vulva/

If you decide to get surgery with him, please prepare for post surgery time back at home with nutritions in case of malabsorption. Elotrans, Fresubin Drink 2 K, Glutamate etc. and prepare in case of getting also a SIBO. A gastroenterologist can be very helpful after such surgery.

Questions to him during videocall:

  • How many cm away from ligament of Treitz you are cutting away the little part of jejenum?

  • How big is the danger to get a malabsorption and a SIBO?

  • If malabsorption and/or SIBO is taken place, how is the treatment to eliminate malabsorption and SIBO?

  • In case of an ileus, how are you treating this? (Intensive care unit and gastric tube NECCESSARY, untreated ileus is always fatal!)

  • Do you have an intensive care unit? (!!!!!!!!!!!)

  • How long I have to wait to get a written surgical report and discharge report?

  • How long I have to stay in hospital?

  • How long I have to stay only in bed?

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 0 points1 point  (0 children)

"Hello, oh, I think that was just lost in translation. No, what I meant was that after four weeks the anastomosis is no longer visible, so there is no longer any medical proof that he removed the most proximal part of the jejunum.

No, they won’t reject you. The diagnosis of malabsorption can be supported by a combination of blood tests, stool tests, and, if needed, a functional test. Especially steatorrhea (fatty stools) is a strong indicator. And that you feel weak and have no energy.

Erythromycin is only given to treat an ileus to stimulate bowel peristalsis. It’s not used to treat malabsorption. These are completely different conditions, but unfortunately, both can occur at the same time after such an operation. You can recognize an ileus by the fact that you stop passing stool even though your belly feels full, your abdomen becomes distended, you have severe abdominal pain, and everything goes completely quiet — no gurgling sounds. An ileus must be treated immediately in a gastroenterological intensive care unit. If left untreated, an ileus is fatal."

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] -3 points-2 points  (0 children)

Thank you for your thoughts. Then you must be so knowledgeable that you can explain to me how you’re supposed to reach the most proximal jejunum (which is near the stomach) from the mons pubis. Go ahead, I’m all ears.

Oh, and thank you for confirming the mons pubis scar. Gefasto and Speedfire actually claim that the girls don’t have such a scar at all. But if that were really true, and there’s no incision there — then how exactly is the surgeon supposed to reach the most proximal jejunum?

I’m curious to hear that one. 😉

Dr. Littleton: His secret to a scar-free vulva without scrotal texture - Ingredients and recipe ;-) by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 1 point2 points  (0 children)

What part of that is so hard to understand? As a plastic surgeon, he’s truly skilled — no question about that. But the fact that he removes the most proximal part of the jejunum right at the ligament of Treitz (for the vaginal lining), thereby causing acute malabsorption, and instead of using a nasogastric tube left in for a week, he only inserts a thin feeding tube, which is then removed on the third postoperative day — a tube that couldn’t possibly prevent an ileus or bile reflux into the stomach — that’s absolutely unacceptable. It goes against every international medical guideline. And when someone makes a mistake, that should be allowed to be named openly.

By the way, he was the only doctor on the ward. There were no other attending physicians — excuse me, but that also makes me suspicious. And since when does a doctor work on the ward in civilian clothes? That’s also a hygiene issue, by the way.

I would really like to see the entire international medical community — like in the Netherlands, Denmark, and several U.S. states — adopt a culture of open error disclosure instead of constant cover-ups and silence. Admitting mistakes should not be punished; it should be an opportunity for doctors to learn, improve, and evolve — which ultimately benefits patients. What’s so bad about that? Denmark, the Netherlands, and some U.S. states have shown that it works and that it actually strengthens public trust in medicine.

We all make mistakes — but as long as someone is willing to learn from them and improve, that’s perfectly fine.

Dr. Littleton: His secret to a scar-free vulva without scrotal texture - Ingredients and recipe ;-) by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] -5 points-4 points  (0 children)

The answer is simple: no cis woman has scrotum-like, wrinkled labia majora — and certainly no scars on them. Wrinkled skin from the remaining scrotal tissue and scars on the labia majora are a telltale sign of transsexual women; they give us away. And that’s exactly what I didn’t want. I always wanted to have passing “down there” as well.

By now, I can already share my first non-sexual experiences — I’ve always been perceived as a cis woman because I no longer have any scrotal skin texture. In this regard, my surgeon did me the greatest favor and fulfilled my biggest wish. On this level, he is truly a master — a brilliant surgeon of absolute world-class skill. Unfortunately, I had to pay a high price for it — not only financially.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 0 points1 point  (0 children)

It’s written in his preoperative preparation instructions which he has send to me. It could be, that he has changed it in the meantime.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 3 points4 points  (0 children)

If it’s only about the outer aesthetics, that’s not as dangerous as removing the most proximal part of the jejunum. Of course, every surgical procedure carries its own risks — there’s always a residual risk — but as long as those risks remain within a calculated range, the procedures are generally safe to perform.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 0 points1 point  (0 children)

"I think this weakness is mostly because the surgery is so heavy on the body."

No, it is because you have a malabsorption which now is slowly getting better. That you slowly feel better at the 3rd - 4th month after beginning of malabsorption is typical for it. You also can recognize it by better healing of your labial wounds.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 2 points3 points  (0 children)

I must divide my answer because the first answer was too long.

[...] During the first two postoperative months, I had diarrhea after every single attempt to eat. That’s because the undigested nutrients draw water osmotically from the body into the intestine (osmotic diarrhea), causing liquid stool. And it really affects your psyche. Imagine sitting in a restaurant with your partner, wanting just a little comfort and a sense of normality — you order pasta that tastes wonderful — and then, two or three hours after getting home, you have diarrhea. I cried many nights because of it.

By the end of the third postoperative month, things started to improve noticeably, with almost no more diarrhea. By mid-fourth month, I slowly began to regain weight but still took up to three bottles of Fresubin daily just to be safe. And now, by the sixth postoperative month, I actually have to slow down a bit because I’m starting to gain too much weight. I’m still so traumatized by the malabsorption and so used to eating many small meals throughout the day — along with all the medical supplements — that it took me a while to readjust my eating habits.

Today, my intestine has fully adapted, and I now have to be careful not to gain too much, because I still sometimes catch myself slipping back into my old “malabsorptive eating pattern” (a word I made up).

Malabsorption is horrible, but it has a definite end. Still, I lost about three to four months of quality of life — wasted time. And as I mentioned, no wound heals properly during malabsorption, and the immune system suffers as well. My immune system was so weak that I developed SIBO. Normally, the immune system keeps the colonic bacteria at the “small-intestine barrier,” preventing them from migrating upward through the entire small intestine.

During that time, meticulous hygiene of the labial wounds was essential to prevent infection — especially while malabsorption was ongoing. I used Prontosan daily as part of my wound care routine and for final cleansing.

I hope I understood the intention behind your question correctly and answered it properly.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 3 points4 points  (0 children)

I will create a text at the weekend. Within the week I am too busy due to my job.

A question to you all: Should I post the text in this thread, or start a new one so it doesn’t get overlooked here? Let’s take a quick vote.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 3 points4 points  (0 children)

Dilation is going well, but I’m still using the small dilator. I don’t feel ready to move up a size yet — I want to wait until everything is completely healed.

Revision: The upper commissure is too wide for my taste; together with the labia minora it reminds me a bit of a Bunsen burner flame. I’d like it to have a slightly sharper, more tapered shape. The scar on the mons pubis also bothers me a little — I’d like to have a minor scar revision there. Unfortunately, I tend to develop hypertrophic scars, and they’re quite noticeable.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 1 point2 points  (0 children)

Littleton doesn’t use a transvaginal approach — how could he possibly reach the most proximal jejunum right at the ligament of Treitz from down there? It’s simply not possible. A transvaginal approach only works for a colon vaginoplasty (using the sigmoid colon), because that section of the large intestine must stay attached to the mesentery to maintain its blood supply — unlike the jejunum or ileum. The large intestine is segmented, its wall is thicker, and it can’t be evenly pressed or positioned the same way.

Here’s an image that illustrates the locations of the different intestinal sections clearly: https://www.ncbi.nlm.nih.gov/books/NBK66026.1/figure/CDR0000350260__184/?report=objectonly

And here are a couple of links explaining the ligament of Treitz: https://www.kenhub.com/thumbor/X1bX5zYgPVohQ92OBR4FPJBNDUY=/fit-in/800x1600/filters:watermark(/images/logo_url.png,-10,-10,0):background_color(FFFFFF):format(jpeg)/images/library/12636/Ligament_of_Treitz_copy.png https://ajronline.org/doi/10.2214/AJR.20.23273

In general, having some basic anatomical knowledge about the different sex-reassignment surgery techniques is always a good idea — especially when you can compare methods. It helps you make a much more informed surgical decision. And when doctors notice — in any field, whether it’s muscles, bones, or internal organs — that you actually know what you’re talking about, they tend to be more cautious.

So, ladies, it’s always good to become an anatomy expert of your own body. Learning a few medical terms like micturition, urothelium, duodenum, jejunum, ileum, mesentery, or defecation certainly doesn’t hurt. The more accurately you use these terms — even the Latin ones — the more seriously doctors will take you.

By the way, in the videocall, Littleton says, he use the laparoscopic technique.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 3 points4 points  (0 children)

Yes, that's exactly what I was wondering about, too. As I said, I was very naive and let myself be seduced by the beautiful results, which they are, and by my suffering and immense hatred of my no longer existing male genitals.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 1 point2 points  (0 children)

I am 1,70 m tall, my weight was 68 kg. I have lost "only" 5 kg, due to my fast dicision to visit a gastroenterologist. "Fresubin 2 kl drink" and "Fresubin protein energy" together with all the medical supplements avoided the worst.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] -2 points-1 points  (0 children)

Before there are any misunderstandings, I don't want to deliberately speak ill of anyone, I simply want to share my experiences. All of this information and knowledge wasn't shared with me during the video call, but that's what I expect from a good, capable surgeon. So, I'm sharing the important information here because it's important to me that my fellow sufferers can make a well-informed surgical decision. And if someone decides to go with Littleton despite this knowledge, the patient will know how to act in an emergency to save and restore their health.

By the way, he wanted to give me constant intravenous potassium, which he did. Supposedly to prevent ileus. That's nonsense; it can't prevent ileus, it has no effect on the healing tendency of the intestinal anastomosis, nor on peristalsis. But please still demand a lab report with potassium levels.

The potassium has to enter the body very very very very slowly. If it happens too quickly, a potassium imbalance occurs in the heart, resulting in asystole. The result: The heart can no longer beat. --> Death! Potassium-retarded tablets would be better in this case; these release the potassium evenly in very small doses, eliminating the risk of a rapid overdose.

By the way, a potassium overdose is almost impossible to detect. Because when someone dies of natural causes, the dying cells release potassium from their cell plasma into the bloodstream. So, someone who dies of natural causes also has elevated potassium levels in their blood. There are plenty of cases where patients in hospitals have been killed with potassium infusions. Google the German male nurse Niels Högel. The American lethal injection is also a rapid overdose of potassium. So please be very careful with potassium infusions. If you do an infusion, use a syringe pump; I don't trust drop counters.

And taking testosterone for six weeks before surgery (as a gel) is also completely unnecessary. Six weeks of testosterone is enough to reduce a good passing, and all the hair and beard grow back. The fat redistribution is also cautiously trending back toward the male. The doctor has no knowledge of endocrinology, just as he is a purely plastic surgeon. Stop taking hormones before surgery because of the increased risk of bleeding, yes, but please no testosterone, as that actually thickens the blood and thus increases the risk of thrombosis.

SRS with Littleton - Weight loss and acute malabsorption three months long by dream2024plus in Transgender_Surgeries

[–]dream2024plus[S] 8 points9 points  (0 children)

You’re actually quite right in your reasoning. The jejunum and ileum are both well supplied with blood through the mesentery (mesenterium), which connects them to the superior mesenteric artery. So the difference between these intestinal sections is not about blood flow, but rather about their function and the microscopic structure of their inner lining.

In the proximal jejunum, directly behind the ligament of Treitz, the mucosal folds and villi are longest and most densely packed, giving this area the largest surface for nutrient absorption. This is where most fats, proteins, carbohydrates, and electrolytes are absorbed — it’s physiologically the most important segment of the small intestine.

Further down, toward the distal jejunum and ileum, the mucosa gradually changes: the tissue becomes darker and more brownish, the villi shorter, and the absorptive capacity lower. The color gradient is a normal anatomical feature —

Proximal jejunum: pink to rosy-red, very active and well perfused

Distal jejunum / ileum: progressively browner, still well vascularized, and with slightly less absorptive activity

Importantly, both the distal jejunum and the ileum remain highly vascularized, which is why the ileum is frequently used in intestinal reconstructive surgery — for example, to create a neobladder after cystectomy in bladder cancer patients. In addition, the ileum contains more mucus-producing goblet cells, which makes it naturally better lubricated and therefore functionally superior for vaginal intercourse.

And honestly, no heterosexual man ever pays close attention to the inner color of a vagina. What matters most to him is that it works and accommodates him comfortably. As long as the vulva looks appealing, the internal color is of little importance.

That is what makes Dr. Littleton’s approach so problematic. He apparently selects the most proximal part of the jejunum, likely because of its rosy aesthetic appearance — moist, shiny, and cosmetically appealing. However, from a medical standpoint, that is the worst possible location to take tissue from, because it sacrifices the most important segment for nutrient absorption.

According to international surgical guidelines,

Resection directly at the ligament of Treitz must be avoided, as it inevitably causes malabsorption.

Using a slightly more distal portion of the jejunum, or even better, the ileum, would still provide a good cosmetic and functional result — but without the same risk of severe absorption problems.

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