title: Laparoscopic-assisted vaginal pull-through: A new approach for congenital adrenal hyperplasia patients with high urogenital sinus.
abstract: BACKGROUND
  To open vaginal cavity to the pelvic floor is part of surgical treatment for urogenital sinus (UGS) in girls with congenital adrenal hyperplasia (CAH). For high UGS, this operative procedure can be challenging and may jeopardise urinary continence. Combined perineal and laparoscopic approaches could be useful to minimise perineal dissection and to facilitate the vaginal lowering.
  
  
  METHODS
  We report the procedure of a laparoscopic-assisted vaginal pull-through for supra-sphincteric UGS in a 5-year-old girl with CAH. Laparoscopic dissection of the vagina from the posterior wall of the bladder and urethra, division of the confluence and vaginal pull-through to the perineum are described.
  
  
  CONCLUSIONS
  The technique is derived from laparoscopic-assisted treatment for high ano-rectal malformations. Compared with current procedures for treatment for high UGS, laparoscopic-assisted approach allows mobilising vagina with minimal dissection of perineum and complete preservation of urethra. Another major advantage is to provide a direct vision for dissection of the space between rectum and urethra prior to vaginal pull-through.
  
  
  CONCLUSIONS
  Laparoscopic-assisted vaginal pull-through appears to be an interesting approach for high UGS in CAH patients, reducing dissection and risk of urinary incontinence. This new approach needs to be strengthened by other cases.
authors.forename: Jacques
authors.initials: J
authors.lastname: Birraux
authors.forename: Faustin Tambo
authors.initials: FT
authors.lastname: Mouafo
authors.forename: Sophie
authors.initials: S
authors.lastname: Dahoun
authors.forename: Veronique
authors.initials: V
authors.lastname: Tardy
authors.forename: Yves
authors.initials: Y
authors.lastname: Morel
authors.forename: Pierre
authors.initials: P
authors.lastname: Mouriquand
authors.forename: Claude
authors.initials: C
authors.lastname: Le Coultre
authors.affiliation: Department of Paediatric Surgery, University Claude Bernard Lyon 1, Hôpital Femme Mère Enfant, 69677 Bron Cedex, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Mure
mesh_terms: D000015:Abnormalities, Multiple; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000601:surgery*; D000071056:Anorectal Malformations / Q000175:diagnosis / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D014621:Vagina / Q000601:surgery*