APPROACHES TO LABIAL FUSION: 3 YEARS EXPERIENCE OF A TRAINING AND RESEARCH HOSPITAL IN THE BLACK SEA REGION

Abstract

Objective: Labial fusion is a prevalent pediatric gynecological condition. This study aimed to conduct a retrospective analysis of patients diagnosed with labial fusion and treated in the Pediatric Surgery department of a tertiary hospital. The primary focus was on evaluating the topical and interventional modalities employed in the treatment of labial fusion and assessing the rates of recurrence. Materials and Methods: A retrospective evaluation was conducted on 520 patients treated for labial fusion at the Pediatric Surgery Clinic of Samsun Training and Research Hospital between January 1, 2020, and January 1, 2023. The investigation encompassed an analysis of patients' ages at the time of diagnosis, presenting symptoms, the application of topical, surgical, and combined therapeutic strategies, and the post-treatment recurrence rates of labial fusion. Results: Labial fusion was diagnosed in 520 patients, with ages ranging from 1 to 148 months and a mean age of 17.05±19.56 months. While a considerable proportion of patients were asymptomatic, symptomatic cases manifested urinary and vaginal symptoms. Initial treatment involved the application of topical agents to all patients. Notably, many cases referred to pediatric surgery clinics had previously undergone unsuccessful topical treatments administered by pediatricians at different medical institutions, prompting subsequent referral for manual separation. Success was achieved in 128 patients with topical treatment (98 estrogen, 30 betamethasone). Interventional procedures were performed on 392 patients, with an additional two weeks of topical treatment following the intervention for all relevant groups. Among the 95 patients undergoing manual separation, 1-5 recurrences were observed, while no recurrences were noted with repeated combined treatment. Statistically, higher labial fusion recurrence rates were identified in older age groups. Conclusion: In the management of labial fusion, we advocate for the importance of employing topical estrogen or betamethasone as non-invasive and secure treatment modalities. Considering the potential risks associated with prolonged topical therapy, manual or surgical separation is contemplated for patients exhibiting inadequate response to a two-week treatment course. Furthermore, we underscore the imperative for additional research to assess the long-term success of pre-pubertal labial adhesions and highlight the efficacy of post-surgical topical treatment as a prophylactic measure.