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Recurrence rates after surgical management of labial adhesions.

INTRODUCTION: Labial adhesions (LA) involves fusion of the labia minora in the midline. LA can range from involving just a small portion of the labia minora or the entire length, covering the urethra and vaginal opening. Treatment for labial adhesions includes the use of topical creams, manual lysis or surgical separation. The recurrence rate has been reported as 55%, 33% and 0% respectively. Only one study with a cohort of 9 patients examines recurrence rates after surgical release (0%).

OBJECTIVE: To verify the previous findings that surgical repair has low recurrence rate. We hypothesize the recurrence rate of LA after surgical repair to be lower than more conservative methods but that the recurrence rate is not 0%.

STUDY DESIGN: A retrospective review was performed of consecutive cases of LA that were treated surgically from August 2018 to October 2020. The surgical technique used involved opening the LA bluntly then oversewing each labia with fine absorbable suture. All patients were scheduled for clinic or telephone follow up 3 months postoperatively. Patient demographics, indication for procedure, history of prior treatment, operative time, complications, recurrence and length of follow up were recorded and are described using non-parametric methods.

RESULTS: Thirty-two female patients underwent surgical treatment of LA using the above-described technique. Median age at surgery was 3.7 y (IQR 2.7-5.3). Most patients (78.1%) had failed prior initial treatment, most commonly topical estrogen creams. Median follow up was 4.3 mos with 10 patients being lost to follow up. Only 2 patients experienced a recurrence at a median of 3.5 months.

CONCLUSIONS: This series verifies prior findings that, in the short-term, surgical repair has a lower recurrence rate than topical treatment or manual lysis. However, the recurrence rate is 9%, higher than previously reported. Further studies into longer-term follow up are underway.

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