title: Laparoscopic removal of müllerian duct remnants in boys.
abstract: OBJECTIVE
  Müllerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the müllerian duct to regress due to insufficient production or peripheral action of müllerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described.
  
  
  METHODS
  Six males were treated from February 1998 to February 2003. Age at surgery was between 3 and 18 years (mean 8.6). All patients showed severe hypospadias and 2 had mixed gonadal dysgenesis with ambiguous genitalia. Three patients presented with urogenital infections and all had a large MDR. Laparoscopic procedures, which were preceded by cystoscopy, were performed using a 10 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. The remnants were ligated with endoscopic loops or an endoscopic GIA stapler and cut.
  
  
  RESULTS
  Mean operative time was 2 hours. We noted no complications. In 2 cases there was deferential ectopia and in another of mixed gonadal dysgenesis bilateral gonadectomy was performed because of the risk of degeneration. Feeding started on postoperative day 1 and the patients were discharged home on day 5. After a followup of 8 months to 4 years all boys were healthy.
  
  
  CONCLUSIONS
  Multiple approaches are used in traditional surgery, often leading to complications. Laparoscopy improves the view, decreases surgical risk and operative time, avoids large scars and allows more rapid hospital discharge.
authors.affiliation: Clinica Chirurgica Pediatrica, Università degli Studi di Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lima
authors.forename: Antonio
authors.initials: A
authors.lastname: Aquino
authors.forename: Marcello
authors.initials: M
authors.lastname: Dòmini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruggeri
authors.forename: Michele
authors.initials: M
authors.lastname: Libri
authors.forename: Marcello
authors.initials: M
authors.lastname: Cimador
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pelusi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods