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Year : 2015  |  Volume : 12  |  Issue : 3  |  Page : 177-180

Laparoscopic-assisted vaginal pull-through: A new approach for congenital adrenal hyperplasia patients with high urogenital sinus

1 Paediatric Surgery, Department of Pediatrics Children's Hospital, University Hospital of Geneva, Rue Willy Donzé 6, 1211 Genève 14, Switzerland
2 Department of Surgery and Specialties, Faculty of Medicine and Biomedical Science, Pediatric Surgery Unit, Yaounde Gyneco-Obstetric and Pediatric Hospital of Yaounde, University of Yaounde I, Yaounde, Cameroon
3 Medical Genetic, Department of Genetics, University Hospital of Geneva, Rue Michel Servet 1, 1211 Genève 14, Switzerland
4 Department of Molecular Endocrinology and Rare Diseases, Molecular Endocrinology and Rare Diseases, University Claude Bernard Lyon 1, Hôpital Femme Mère Enfant, France
5 Department of Paediatric Surgery, University Claude Bernard Lyon 1, Hôpital Femme Mère Enfant, 69677 Bron Cedex, France

Correspondence Address:
Pierre-Yves Mure
GHE-HFME, 59, Boulevard Pinel, 69500 Bron
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-6725.170191

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Background: To open vaginal cavity to the pelvic floor is part of surgical treatment for urogenital sinus (UGS) in girls with congenital adrenal hyperplasia (CAH). For high UGS, this operative procedure can be challenging and may jeopardise urinary continence. Combined perineal and laparoscopic approaches could be useful to minimise perineal dissection and to facilitate the vaginal lowering. Patients and Methods: We report the procedure of a laparoscopic-assisted vaginal pull-through for supra-sphincteric UGS in a 5-year-old girl with CAH. Laparoscopic dissection of the vagina from the posterior wall of the bladder and urethra, division of the confluence and vaginal pull-through to the perineum are described. Discussion: The technique is derived from laparoscopic-assisted treatment for high ano-rectal malformations. Compared with current procedures for treatment for high UGS, laparoscopic-assisted approach allows mobilising vagina with minimal dissection of perineum and complete preservation of urethra. Another major advantage is to provide a direct vision for dissection of the space between rectum and urethra prior to vaginal pull-through. Conclusion: Laparoscopic-assisted vaginal pull-through appears to be an interesting approach for high UGS in CAH patients, reducing dissection and risk of urinary incontinence. This new approach needs to be strengthened by other cases.

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