Academic Journal
Laparoscopically Assisted Vaginal Pull-Through in 7 Cases of Congenital Adrenal Hyperplasia with High Urogenital Sinus Confluence: Early Results
| Τίτλος: | Laparoscopically Assisted Vaginal Pull-Through in 7 Cases of Congenital Adrenal Hyperplasia with High Urogenital Sinus Confluence: Early Results |
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| Συγγραφείς: | Khaled S. Abdullateef, Gamal H. El Tagy, Mahmoud M Marei, Ahmed Fares, Sherif N. Kaddah |
| Πηγή: | Journal of Laparoendoscopic & Advanced Surgical Techniques. 29:256-260 |
| Στοιχεία εκδότη: | Mary Ann Liebert Inc, 2019. |
| Έτος έκδοσης: | 2019 |
| Θεματικοί όροι: | 03 medical and health sciences, 0302 clinical medicine, Adrenal Hyperplasia, Congenital, Child, Preschool, Dissection, Vagina, Humans, Infant, Female, Laparoscopy, Plastic Surgery Procedures, Perineum, 3. Good health |
| Περιγραφή: | Surgical management of the high urogenital sinus (UGS) is challenging. Presence of a short urethra is a contraindication for UGS mobilization as this is likely to affect urinary continence. In addition, vaginal reconstruction of the high suprasphincteric confluence is complex and prone to complications and failure.This study included 7 girls who underwent a laparoscopically assisted vaginal pull-through in the past 2 years. All cases included were diagnosed with congenital adrenal hyperplasia (CAH), with a high UGS, and a short urethra of ≤15 mm above the confluence. Patients were preoperatively assessed by genitography. Mobilization of the vagina was pursued until the confluence became visible and the vaginal caliber tapered off at its junction with the urethra. The connection was sutured or clipped and divided. Uterine round ligaments were divided to allow delivering the vagina to the perineum with minimum tension. The tract for the pull-through was created and the vagina was pulled outside and sutured to the perineal skin. Good vaginal mobilization allowed a direct perineal anastomosis without skin flap augmentation of the vaginal wall. Clitoroplasty and labiaplasty were deferred.Mobilization of the vagina was possible in all cases attempted, without injuries to the adjacent pelvic structures. Calibration and dilatation started 2 weeks postoperatively. At 12-month follow-up, all the patients had a patent vagina with good caliber, and were able to retain urine without dribbling.The laparoscopically assisted vaginal pull-through approach provides optimal exposure, facilitates vaginal dissection, separation from the urethra, and avoids injuries to the urinary structures. This allows vaginal reconstruction without tension. |
| Τύπος εγγράφου: | Article |
| Γλώσσα: | English |
| ISSN: | 1557-9034 1092-6429 |
| DOI: | 10.1089/lap.2018.0194 |
| Σύνδεσμος πρόσβασης: | https://pubmed.ncbi.nlm.nih.gov/30256163 https://europepmc.org/article/MED/30256163 https://www.liebertpub.com/doi/abs/10.1089/lap.2018.0194 https://www.ncbi.nlm.nih.gov/pubmed/30256163 https://pubmed.ncbi.nlm.nih.gov/30256163/ |
| Rights: | Mary Ann Liebert TDM |
| Αριθμός Καταχώρησης: | edsair.doi.dedup.....907bf254d57a1b5454a2e3087193c260 |
| Βάση Δεδομένων: | OpenAIRE |
| ISSN: | 15579034 10926429 |
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| DOI: | 10.1089/lap.2018.0194 |