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[Labial fusion in the paediatric surgery department of Yopougon University hospital (Côte d'Ivoire): 108 cases].

INTRODUCTION: Labial fusion is a benign genital disorder in girls. It may be either congenital or acquired, sometimes due to poor hygiene. Parental panic about this "absent vagina" contrasts with its simple, rapid, radical treatment. The study reports the result of simplified treatment.

MATERIAL AND METHODS: This retrospective study covers cases from 1 January 1992 through 31 December 2006 and includes only the cases of young girls treated as outpatients. All patients underwent outpatient surgical treatment. They were placed in gynaecological position. After asepsis of the vulva, a curved Halsted mosquito forceps was inserted into the opening for partial adhesions or across the medial transparent membrane for complete fusion. The forceps were then opened gently until complete detachment occurred. Local anaesthesia with EMLA cream ensured the absence of pain; there was sometimes minimal bleeding. All patients had local antiseptic treatment afterwards.

RESULTS: During this study period, 108 patients (including two sisters) with a mean age of 22 months were treated for labial fusion (101 cases of total fusion and 7 partial). Only seven were older than 5 years of age. Overall, 84 patients underwent this basic treatment of section and follow-up antisepsis; none had a recurrence. Twenty girls also received oestrogen cream, and 4 had the surgical section alone.

DISCUSSION: This benign disorder is rare and generally isolated in our regions, unlike in Western countries where it is often associated with hormonal deficits. The principal approach has been either therapeutic abstention or oestrogen therapy, both currently recommended in developed countries. Oestrogen treatment is a long procedure (3 or 4 months), however, and follow-up is far from certain. In Africa, all genital disorders are considered serious. Early repair is desirable for that reason and to prevent urinary tract infections and traditional "treatment". Simple outpatient treatment by surgical section with local antiseptic treatment is effective. Vulvar hygiene is essential to prevent recurrence.

CONCLUSION: This benign disorder can be treated by any physician, but the psychological impact of the site and the necessary speed suggest the choice of management in paediatric units.

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