TÇCD 2012 30th Annual Congress of Turkish Pediatric Surgical Association

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Poster - 74

Labial Fusion Separation And İts Long Term Results

Although sticking of Labium minor or major to each other is a frequent occurrence in girls before puberty, it may be in the form of complete or partial fusion. In the etiology of Labial fusion, low estrogen level in prepuberty period is proposed as one of the causes. Although topical estrogen administration is the main treatment method, surgical intervention is required in many patients. Estrogen may prevent the recurrence of labial fusion recurrence.

The aim of the present study was to determine the factors in the etiology of patients presenting  to our hospital with the complaint of abial fusion, to determine the efficacy of estrogen in the separation of labia and the efficacy of treatment and to investigate the factors influencing the recurrence of the problem in  treated patients.

 

MATERIAL AND METHOD

 

The present study was carried out by retrospective survey of girls whose labial fusion were separated in our clinic between the dates of   January  2009-May 2012.   Overall, files of 162 patients were examined.  Those whose perinal opening was closed at least over 50% were included in the study. Before the procedure, Emla cream was applied to perianal regions of the patients and they were kept waiting for one hour. After their labial fusions were separated, they were applied estrogen cream (Estriol) for four weeks. Families were instructed about measures to prevent recurrence and in case of recurrence they were advised to use the cream again for four weeks. They were told to refer to hospital if their compliants do not improve in spite of treatment.

Of the cases included in the study, the youngest was 2 months old and the oldest was 9 years old. In %29,6 of the patients (n= 48)in complete fusion and %70,3 (n=114) partial fusion was seen.

Disease did not recur in %84.5 of the patients (n= 137) while it recurred in %15.4 (n= 25). Disease recurred once in %25 of the patients (n=7) , twice in %36 (n=9) and three time or more in the remaining %36 (n= 9).

Disease recurred most commonly inthe patients between the ages of 5-6, while it recurred least commonly in those between the ages of 3-4.

The age distribution and number of recurrence is patients with recurring complaints is as follows:

 

 

Although sticking of Labium minor or major to each other is a frequent occurrence in girls before puberty, it may be in the form of complete or partial fusion. In the etiology of Labial fusion, low estrogen level in prepuberty period is proposed as one of the causes. Although topical estrogen administration is the main treatment method, surgical intervention is required in many patients. Estrogen may prevent the recurrence of labial fusion recurrence.

The aim of the present study was to determine the factors in the etiology of patients presenting  to our hospital with the complaint of abial fusion, to determine the efficacy of estrogen in the separation of labia and the efficacy of treatment and to investigate the factors influencing the recurrence of the problem in  treated patients.

 

MATERIAL AND METHOD

 

The present study was carried out by retrospective survey of girls whose labial fusion were separated in our clinic between the dates of   January  2009-May 2012.   Overall, files of 162 patients were examined.  Those whose perinal opening was closed at least over 50% were included in the study. Before the procedure, Emla cream was applied to perianal regions of the patients and they were kept waiting for one hour. After their labial fusions were separated, they were applied estrogen cream (Estriol) for four weeks. Families were instructed about measures to prevent recurrence and in case of recurrence they were advised to use the cream again for four weeks. They were told to refer to hospital if their compliants do not improve in spite of treatment.

 

Of the cases included in the study, the youngest was 2 months old and the oldest was 9 years old. In %29,6 of the patients (n= 48)in complete fusion and %70,3 (n=114) partial fusion was seen.

Disease did not recur in %84.5 of the patients (n= 137) while it recurred in %15.4 (n= 25). Disease recurred once in %25 of the patients (n=7) , twice in %36 (n=9) and three time or more in the remaining %36 (n= 9).

Disease recurred most commonly inthe patients between the ages of 5-6, while it recurred least commonly in those between the ages of 3-4.  

 

Of 25 (%15.4) patients referring to our clinic with recurring complaints, 18 (%72) patients who used estrogen cream prior to referral, and 2 (%8) patients who did not use cream underwent fusion separation procedure with surgical intervention. Among those whose Labial fusion was separated with surgical intervention, patients who did not use estrogen cream and do not have secondary complaints, were recommended to use estrogen cream for four weeks.

The complaints recurred in 9 patients (%36) despite estrogen treatment and they underwent surgical intervention and topical estrogen treatment was reinstituted. In 9 patients (%36), complaints recurred three time sor more and required surgical intervention again.

 

In the present study, it was established that among these with recurrent complaints, second or third recurrence rate was higher in patients undergoing surgical intervention. It was also determined that patients with recurring complaint following treatment responded less to topical estrogen treatment and these patients should undergo surgical intervention.

 

 

Keywords:

Labial Füzyon Açılması ve Uzun Vade Sonuçları

 

Labium minör veya majörlerin birbirine yapışması puberte öncesi kız çocuklarında sık görülen bir durum olmakla beraber kısmi veya tam yapışıklık şeklinde olabilmektedir. Labial füzyon etiyolojisinde nedenlerden biri de puberte öncesi dönemdeki düşük östrojen seviyesi gösterilmektedir. Topikal östrojen tedavisi uygulanması ana tedavi yöntemi olmasına rağmen birçok hastaya cerrahi müdahale gerekmektedir. Östrojen labial füzyon rekürrensini önleyebilmektedir.

Bu çalışmanın amacı, hastanemize labial füzyon şikayeti ile gelen hastalarımızın etiyolojisindeki sebepleri belirlemek, labiumların açılmasında topikal östorjenin etkinliğini saptamak, tedavinin etkinliğini saptamak, tedavisi yapılan hastalarımızda bu hastalığın tekrarının hangi etmenlere bağlı olduğunu araştırmaktır. 

 

MATERYAL VE METOD

Bu çalışma, Ocak 2009-Mayıs 2012 tarihleri arasında polikliniğimizde labial füzyonu açılan kız çocuklarının dosyaları geriye dönük taranmasıyla yapılmıştır. Toplamda 162 hasta dosyası incelenmiştir. Çalışmaya perineal açıklığın en az %50’den fazlası kapanmış olanlar dahil edilmiştir. İşlem öncesi hastaların perineal bölgelerine Emla krem sürülmüş ve bir saat bekletilmiştir. Labial füzyonları açıldıktan sonra hastalara östrojenli pomat (Estriol) 4 hafta süreyle verilmiştir. Hastalığın tekrarlanmaması için ailelere önlemler anlatılmış, tekrarlaması durumunda östrojenli pomadı yeniden 4 hafta süreyle kullanması önerilmiştir. Buna rağmen, yapışıklığın geçmemesi durumunda hastaneye başvurması gerektiği ifade edilmiştir.

Bu çalışmaya dâhil edilen hastaların en küçüğü 2 aylık, en büyüğü ise 9 yaşında olduğu görülmüştür. Hastaların %29,6’sında (n= 48) tam yapışıklık, %70,3’ünde (n=114) kısmi yapışıklık olduğu görülmüştür.

Hastaların %84.5’inde (n= 137) hastalığın tekrarlanması görülmezken, %15.4’ünde (n= 25) hastalık tekrarlanmıştır. Bu hastalık, hastaların %25’inde (n=7) bir kere, %36’sında (n=9) iki kere, diğer %36’sında (n= 9) ise üç kez ve üzeri tekrarlanmıştır. Hastalığın tekrarlanması en çok 5-6 yaş aralığındaki hastalarda meydana gelmiştir. En az tekrarlama ise 3-4 yaş aralığındaki hastalarda yaşanmıştır. 

Şikayetinin tekrar etmesi üzerine yeniden polikliniğimize başvuran 25 (%15.4) hastadan gelmeden önce östrojenli krem kullanmış olan18 hasta ile (%72), kullanmadan gelen fakat şikayeti olan 2 (%8) hastaya cerrahi müdahale ile füzyon açılma işlemi yapılmıştır. Labial füzyonu müdahale ile açılanlarla östojenli krem kullanmadan gelen ve sekonder şikayeti olmayan hastalara ise dört hafta süreyle östrojenli krem kullanılması önerilmiştir.

Topikal östorjenli tedaviye rağmen 9(%36) hastanın şikayeti tekrarlanmış, bu hastalara cerrahi müdahele edilmiş ve yeniden topikal östrojen tedavisi başlanmıştır. Aynı 9(%36) hastanın şikayeti 3 ve üzeri kez yeniden tekrarlanmış ve yeniden cerrahi müdahale gerekmiştir.

Araştırmamızda şikayeti tekrarlayan hastalar arasında cerrahi müdahale edilen hastalarda ikinci ve üçüncü tekrarın daha yüksek olduğu gözlenmiştir. Tedavi sonrası şikayeti tekrarlayan hastaların topikal östrojen tedavisine yanıtının az olduğu, bu hastalara cerrahi müdahale ile tedavi edilmesi gerektiği gözlemlenmiştir

Keywords:

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