What the surgical literature leaves out
There is a reasonable body of work on how peritoneal-flap neovaginoplasty goes. There is very little on what the tissue does afterward — and that gap is the reason this program exists.
Most published work on peritoneal pull-through neovaginoplasty is surgical: complication rates, neovaginal depth, revision frequency, patient-reported satisfaction at fixed follow-up points. It answers, reasonably well, whether the operation succeeds.
It says far less about the tissue as a living, hormone-responsive surface over time — how a microbiome establishes on peritoneal-derived mucosa, how it responds to sustained and cyclical estrogen exposure, how any of it drifts across months and years rather than weeks.
There are understandable reasons for the gap. Longitudinal tissue biology is slow, unglamorous, and hard to fund for a population this size, and outcome studies answer the question surgeons and payers ask first. But “did the surgery work” and “what is this tissue doing a year later” are different questions, and the second one matters enormously to the people living in the result.
This program is narrow on purpose. It does not try to characterize the population — it tries to document, in one body and in detail, the biology the outcome literature skips. If it does its job, it leaves behind specific, testable claims for a study with more than one subject to take up.