WOFAPS 2025 8th World Congress of Pediatric Surgery

Abeer Aboalazayem ¹, Khaled Salah Ahmed Abdullateef ¹, Samah Ahmed Hasanin ¹, Sherif Kaddah ¹, Ahmed Fares ²

¹ Cairo University Faculty of Medicine, Pediatric Surgical Division, Cairo University Specialized Pediatric Hospital, Egypt
² Faculty of Medicine - Fayoum University

Background: 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 supra sphincteric confluence is complex and prone to complications and failure.

Purpose: To assess the outcome of laparoscopic assisted vaginal pull through in cases with high UGS.

Methods: This is a prospective single arm exploratory clinical trial (pilot study) that was conducted on 16 cases. They underwent laparoscopic assisted vaginal pull through. The outcome was evaluated (success of pull through – presence of complication).

Results: Sixteen cases were included in this study. All were diagnosed with “21-hydroxylase deficiency” salt loosing type. All cases had virilised external genitalia ranged from Prader 3 to 5. The median age at the surgical intervention was 32.5 months (range 9-96 months). 13 cases (81.3%) had patent, well vascularised vagina with good calibre during the whole period of follow up. Three cases (18.7%) had obliterated vagina; one with the vaginal injury and using skin flaps, the second one was under extreme tension and the third one who did not dilate the vagina and missed the follow up. Three cases had remnant of original connection (diverticulum). Two cases (16.6%) had urethrovaginal fistula with patent vagina at the perineum.

Conclusion: The laparoscopically assisted vaginal pull-through approach provides optimal exposure that is lacking in perineal approaches. The incidence of complication (fistula, the need to redo surgery) is comparable to what is mentioned in the literature.