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19–22 APRIL, 2017, BARCELONA, SPAIN
PATIENTS (OR MATERIALS) AND METHODS
For two consecutive patients (13 and 14 years) with distal vaginal atresia and long gap between
the remaining vagina and perineum, a combined abdominal laparoscopic dissection and perineal
approach was performed. In this video, we describe the surgical procedure including laparoscopic
vaginal dissection and pull through with perineal anastomosis.
RESULTS
The technique is derived from the laparoscopic assisted treatment for high ano-rectal malformations
and laparoscopic assisted vaginal pull-through for high urogenital sinus in congenital adrenal hyper-
plasia. Compared with current techniques for treatment of distal vaginal atresia with large defect,
the laparoscopic approach allows minimal dissection of the pelvis and perineum. Furthermore,
it provides a direct vision for lowering the vagina in the space between rectum and urethra and
permits a tension free vagino perineal anastomosis.
CONCLUSIONS
Laparoscopic vaginal pull through appears to be a valuable approach for distal congenital vaginal
atresia with large defect. It reduces perineal dissection, better vision of surrounding urinary and
digestive structures and postoperative risk of vaginal introitus stenosis. It makes the operation avail-
able to a wide range of surgeons skilled in laparoscopy.
This preliminary experience needs to be strengthened by other cases.
14:03–14:12
Discussion
S16-7 (P without presentation)
BILATERAL INGUINAL HERNIA IN “FEMALE” NEONATE
RARELY REVEALS A COMPLETE ANDROGEN INSENSIVITY
SYNDROME (CAIS) OR 5 ALPHA REDUCTASE MUTATION
M. OLLIVIER
1
, F. PARIS
2
, S. GARNIER
1
, P. PHILIBERT
2
, N. SERVANT
2
,
P. BORREGO
1
, Mp GUIBAL
1
, D. FORGUES
1
, H. ALLAL
1
, C. LOPEZ
1
, L. GASPARI
2
,
C. SULTAN
2
and N. KALFA
1
1) Hopital Lapeyronie, CHU Montpeller, Urologie Pédiatrique, Montpellier, FRANCE - 2) Hopital Lapeyronie,
CHU Montpeller, Endocrinologie Pédiatrique, Montpellier, FRANCE
PURPOSE
Neonatal inguinal hernia in “girls” may reveal 46XY-DSD including CAIS and SRD5A2 mutations.
However the incidence of underlying DSD remains highly variable due to clinical heterogeneity of
previous series. We aimed to evaluate the incidence of 46XY-DSD among neonates with inguinal
hernia according to its type (uni-bilateral) and content.
MATERIAL AND METHODS
306 neonates with a female phenotype operated for a herniotomy were included retrospectively
(2000-2016). 171 underwent a bilateral repair. Gonads were assessed either by US or by intra
operative direct examination. If CAIS or 5-alpha-reductase mutation was suspected, hormonal dos-
age, karyotype and direct AR (exons 1-8) and SRD5A2 genes sequencing were performed.