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Çocuklarda labial füzyona yaklaşım: 16 yıllık deneyim

Year 2022, Volume 10, Issue 1, 1 - 5, 15.03.2022
https://doi.org/10.21765/pprjournal.1036818

Abstract

Amaç: 3. basamak bir çocuk hastanesinde çocuk cerrahisi polikliniğine başvuran veya konsülte edilen labial füzyonlu hastaları retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: 01/01/2005-31/12/2020 tarihleri arasında çocuk cerrahisi kliniğine labial füzyon nedeni ile başvuran veya konsülte edilen 889 hasta tanı anındaki yaşları, başvuru şikâyetleri, hangi kliniklerden çocuk cerrahisine konsülte edildiği, tedavileri, nüks ve komplikasyonlar açısından retrospektif olarak değerlendirildi.. Bulgular: Hastaların yaş ortalaması 2,21(0,1-11) yıl idi. Hastaların çoğu asemptomatik idi (%82,5). Hastaların %72,3’ü ebeveynlerin fark etmesi ile direk çocuk cerrahisi polikliniğine getirildi. Bunun dışında pediatri poliklinikleri, pediatrik endokrinoloji polikliniği, pediatrik nefroloji polikliniği ve çocuk acilden hastalar kliniğimize konsülte edildi. İlk muayenede, 885 hastaya manuel seperasyon ve 4 hastaya cerrahi uygulandı. Tüm hastalara işlemden sonra 15 gün boyunca ılık suya oturma banyosu ve topikal östrojen tedavisi uygulandı. Manuel seperasyon yapılan 80 (%9) hastada nüks tespit edildi. Nüks olan hastaların 78’ine yeniden manuel seperasyon yapılırken, sert fibrotik füzyonu olan iki hastaya (%2,5) ise cerrahi seperasyon yapıldı. Sonuç: Labial füzyon tedavisinde, manuel seperasyon ve topikal östrojenli krem tedavi kombinasyonunu, poliklinik ortamında güvenilir şekilde uygulanabilir olması ve nüks oranın düşük olmasından dolayı önermekteyiz. Sert, kalın ve fibrotik labial füzyonlarda ise cerrahi seperasyon tercih edilmelidir.

References

  • References 1. Leung AKC, Robson WLM, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health 1993;29:235-6
  • 2. Balcı Ö, Karaman A, Ertürk A et al. Puberte Öncesi Kız Çocuklarında Labial Füzyon. (Labial Fusion in Prepubertal Girls) Türkiye Çocuk Hastalıkları Dergisi, 2015; 9(3), 195-197.
  • 3. Mayoglou L, Dulabon L, Martin-Alguacil N, et al. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol 2009;22: 247-50.
  • 4. Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions? Arch Dis Child 2007;92:268-71 3.
  • 5. Velander MH, Mikkelsen DB, Bygum A. Labial agglutination in a prepubertal girl: effect of topical oestrogen. Acta Derm Venereol 2009;89:198-9.
  • 6. Schober J, Dulabon L, Martin-Alguacil N, et al. Significance of topical estrogens to labial fusion and vaginal introital integrity. J Pediatr Adolesc Gynecol 2006;19(5):337-9
  • 7. Soylu A, Sarıer M, Davarcı M, et al. Labial füzyonun olduğu işeme zorluğu. (Labıal fusion causing micturitional disturbance). Turkish Urol Journal 2004;30(1):117-9.
  • 8. Soyer T. Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic? J Pediatr Adolesc Gynecol 2007;20:241-4.
  • 9. Acer T, Ötgün İ, Öztürk Ö et al. Do hygienic factors affect labial fusion recurrence? A search for possible related etiologic factors. Journal of pediatric surgery. 2012 Oct 1;47(10):1913-8.
  • 10. Türk E, Karaca İ. Prepubertal labial füzyonda tedavi yöntemleri. (Treatment methods in prepubertal labial fusion) Izm Univ Med J 2014;3:33-6
  • 11. Goldman RD. Child health update: estrogen cream for labial adhesion in girls. Can Fam Physician 2013;59:37-8.
  • 12. Saraç F, Büyükbeşe SS, Toptaş M, Saygılı A, Şahin K. Labial Füzyonda Tedavi Yaklaşımlarımız. (Approaches to the Treatment of Labial Fusion) Medical Bulletin of Haseki/Haseki Tip Bulteni. 2016 Jun 1;54(2).
  • 13. Eroğlu E, Yip M, Oktar T, Kayıran SM, Mocan H. How should be treat prepubertal labial adhesions? Retrospective comparison of topical treatments: Estrogen only, betamethasone only, and combination estrogen and betamethasone. J Pediatr Adolesc Gynecol 2011;24:389-91.
  • 14. Silva D, Jayalath GK, Ranaweera AK, Jayawardane M, Sudeshika MD. A new method of surgical treatment for recurrent labial adhesions in a pre-pubertal girl. Ceylon Med J 2012;57:168-9.
  • 15. Soyer T. Labial synechia, imperforated hymen, vaginal agenesis, atresia and stenosis. Turkiye Klinikleri J Pediatr Surg-Special Topics 2009; 2(1):57-64.

Approach to labial fusion in children: 16 years of experience

Year 2022, Volume 10, Issue 1, 1 - 5, 15.03.2022
https://doi.org/10.21765/pprjournal.1036818

Abstract

Aim: We aimed to retrospectively evaluate the patients with labial fusion who presented to or were referred to the pediatric surgery clinic in a tertiary pediatric hospital. Material and Method: Between 01/01/2005 and 31/12/2020, 889 patients admitted or consulted to the pediatric surgery clinic due to labial fusion, age at the time of diagnosis, complaints on admission, which clinic referred the patient to the pediatric surgery clinic, treatments, recurrence, and complications were evaluated retrospectively. Results: The mean age of the patients was 2.21 (0.1–11) years. Most of the patients (82.5%) were asymptomatic. Parents noticed the condition and brought their child directly to the pediatric surgery clinic in 72.3% of the cases. Otherwise, patients were consulted to the pediatric surgery clinic from pediatric clinics, the pediatric endocrinology clinic, the pediatric nephrology clinic, or the pediatric emergency department. During the initial examination, manual separation was performed in 885 patients, and surgery was required for four patients. After the procedures, hydrotherapy with warm water and topical estrogen therapy were applied to all patients for 15 days. Recurrence was detected in 80 (9.0%) patients who were treated by manual separation. Manual separation was performed again in 78 of the patients, while surgical separation was performed in two (2.5%) patients who had severe fibrotic fusions. Conclusion: In the treatment of labial fusion, we recommend the combination of manual separation and topical estrogen cream treatment because it can be applied safely in the clinic, and the recurrence rate is low. Surgical separation is preferred in severe, thick, and fibrotic labial fusions.

References

  • References 1. Leung AKC, Robson WLM, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health 1993;29:235-6
  • 2. Balcı Ö, Karaman A, Ertürk A et al. Puberte Öncesi Kız Çocuklarında Labial Füzyon. (Labial Fusion in Prepubertal Girls) Türkiye Çocuk Hastalıkları Dergisi, 2015; 9(3), 195-197.
  • 3. Mayoglou L, Dulabon L, Martin-Alguacil N, et al. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol 2009;22: 247-50.
  • 4. Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions? Arch Dis Child 2007;92:268-71 3.
  • 5. Velander MH, Mikkelsen DB, Bygum A. Labial agglutination in a prepubertal girl: effect of topical oestrogen. Acta Derm Venereol 2009;89:198-9.
  • 6. Schober J, Dulabon L, Martin-Alguacil N, et al. Significance of topical estrogens to labial fusion and vaginal introital integrity. J Pediatr Adolesc Gynecol 2006;19(5):337-9
  • 7. Soylu A, Sarıer M, Davarcı M, et al. Labial füzyonun olduğu işeme zorluğu. (Labıal fusion causing micturitional disturbance). Turkish Urol Journal 2004;30(1):117-9.
  • 8. Soyer T. Topical estrogen therapy in labial adhesions in children: therapeutic or prophylactic? J Pediatr Adolesc Gynecol 2007;20:241-4.
  • 9. Acer T, Ötgün İ, Öztürk Ö et al. Do hygienic factors affect labial fusion recurrence? A search for possible related etiologic factors. Journal of pediatric surgery. 2012 Oct 1;47(10):1913-8.
  • 10. Türk E, Karaca İ. Prepubertal labial füzyonda tedavi yöntemleri. (Treatment methods in prepubertal labial fusion) Izm Univ Med J 2014;3:33-6
  • 11. Goldman RD. Child health update: estrogen cream for labial adhesion in girls. Can Fam Physician 2013;59:37-8.
  • 12. Saraç F, Büyükbeşe SS, Toptaş M, Saygılı A, Şahin K. Labial Füzyonda Tedavi Yaklaşımlarımız. (Approaches to the Treatment of Labial Fusion) Medical Bulletin of Haseki/Haseki Tip Bulteni. 2016 Jun 1;54(2).
  • 13. Eroğlu E, Yip M, Oktar T, Kayıran SM, Mocan H. How should be treat prepubertal labial adhesions? Retrospective comparison of topical treatments: Estrogen only, betamethasone only, and combination estrogen and betamethasone. J Pediatr Adolesc Gynecol 2011;24:389-91.
  • 14. Silva D, Jayalath GK, Ranaweera AK, Jayawardane M, Sudeshika MD. A new method of surgical treatment for recurrent labial adhesions in a pre-pubertal girl. Ceylon Med J 2012;57:168-9.
  • 15. Soyer T. Labial synechia, imperforated hymen, vaginal agenesis, atresia and stenosis. Turkiye Klinikleri J Pediatr Surg-Special Topics 2009; 2(1):57-64.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Can İhsan ÖZTORUN (Primary Author)
ANKARA YILDIRIM BEYAZIT ÜNİVERSİTESİ TIP FAKÜLTESİ ÇOCUK CERRAHİSİ A.B.D.
0000-0002-5408-2772
Türkiye


Elif Emel ERTEN
Ankara City Hospital, Pediatric Surgery Clinic
0000-0002-3666-295X
Türkiye


Süleyman Arif BOSTANCI
Ankara City Hospital, Pediatric Surgery Clinic
0000-0002-7512-3895
Türkiye


Şükrüye DEMİRKAYA
Ankara City Hospital, Pediatric Surgery Clinic
0000-0003-3266-3311
Türkiye


Ahmet ERTÜRK
Ankara City Hospital, Pediatric Surgery Clinic
5000-0000-3028-6362
Türkiye


Sabri DEMİR
Ankara City Hospital, Pediatric Surgery Clinic
0000-0003-4720-912X
Türkiye


Doğuş GÜNEY
ANKARA YILDIRIM BEYAZIT UNIVERSITY, SCHOOL OF MEDICINE
0000-0001-7168-2123
Türkiye


Gülsen KESKİN
Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Anesthesiology
0000-0002-9990-5533
Türkiye


Müjdem AZILI
ANKARA YILDIRIM BEYAZIT UNIVERSITY, SCHOOL OF MEDICINE
0000-0002-5137-7209
Türkiye


Emrah ŞENEL
ANKARA YILDIRIM BEYAZIT UNIVERSITY, SCHOOL OF MEDICINE
0000-0002-0383-4559
Türkiye

Publication Date March 15, 2022
Acceptance Date December 31, 2021
Published in Issue Year 2022, Volume 10, Issue 1

Cite

Vancouver Öztorun C. İ. , Erten E. E. , Bostancı S. A. , Demirkaya Ş. , Ertürk A. , Demir S. , Güney D. , Keskin G. , Azılı M. , Şenel E. Approach to labial fusion in children: 16 years of experience. Pediatric Practice and Research. 2022; 10(1): 1-5.