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Is Labioplasty the Best Option in Adolescence?


 

From the Annual Meeting of the North American Society for Pediatric and Adolescent Gynecology

Major Finding: There were no intraoperative or major postoperative complications, and 10 patients (27%) experienced minor postoperative complications.

Data Source: Retrospective analysis of 37 girls with symptomatic labial hypertrophy who underwent bilateral or unilateral labioplasty with or without clitoral hood revision.

Disclosures: Dr. Santos and Dr. Dietrich reported no relevant financial disclosures.

CHICAGO – Labioplasty resulted in high rates of satisfaction and few complications in what is being described as the largest series of pediatric and adolescent females undergoing labioplasty for symptomatic labial hypertrophy.

The study in 37 girls, aged 7–17 years, evoked strong responses when presented at the meeting.

One audience member said she was disturbed by the age range of the participants, and questioned why labioplasty was even performed in a 7-year-old.

Principal investigator Dr. Xiomara M. Santos replied that the child had extensive labial hypertrophy due to chronic masturbation and experienced no complications as a result of surgery. The girl also had been diagnosed with precocious adrenarche. Dr. Santos stressed that in no case was a procedure performed for cosmetic reasons, and that patients and their mothers received extensive counseling on the risks and benefits prior to surgery.

Senior author Dr. Jennifer Dietrich, chief of gynecology at Texas Children's Hospital in Houston, said in an interview that labioplasty in adolescents is safe and effective for symptomatic labial hypertrophy, but that counseling and education cannot be emphasized enough. She noted that only two girls in the series were prepubertal: the 7-year-old and an 8-year-old with precocious puberty who developed symptomatic labial hypertrophy after vulvar trauma. Both girls had failed conservative management and underwent surgery because of considerable hygiene difficulties and chronic discomfort.

“Ultimately, these are procedures for patients who are symptomatic enough that it affects their daily life,” she said. “Patients and parents who consent regardless of conservative measures attempted are making a very private choice in this matter based on quality of life issues.”

The 37 girls underwent either bilateral or unilateral labioplasty with or without clitoral hood revision under general anesthesia between July 2007 and June 2010. Symptomatic labial hypertrophy was defined as labia minora of more than 4 cm, with 60% of patients having labia of 7–8 cm. The mean age was 12.6 years.

The straight surgical technique was used bilaterally in 17 patients and unilaterally in 5, the wedge excision technique bilaterally in 1 and unilaterally in 3, the elliptical technique in only 3 patients bilaterally, and the contoured technique bilaterally in only 1 patient. Clitoral hood revision for clitoral hood hypertrophy was performed in six patients. One patient underwent surgery after trauma.

Postoperative perineal care included conjugated estrogen cream and bacitracin in 34 patients and Silvadene cream in 3 patients, with sitz baths twice daily.

No intraoperative or major postoperative complications were reported among the 37 patients, with 10 (27%) experiencing minor postoperative complications, said Dr. Santos, a clinical fellow at Texas Children's Hospital. The complications included three wound infections, two cases of wound dehiscence, two wound hematomas, reaction to the prescribed cream in two patients, and severe postoperative pain requiring admission in one patient. All complications resolved with minor interventions by 6 weeks post procedure, with 70% resolving by 3 weeks.

Noncompliance with postoperative perineal care occurred in 27% of patients and was significantly correlated with having a minor postoperative complication, Dr. Santos said. No statistically significant correlation was identified with complication rates and surgical technique, suture type, type of procedure, body mass index (BMI), age, and age at menarche. Two patients were not satisfied with the surgery, resulting in an overall satisfaction rate of 94%.

Among 34 patients with long-term follow-up available, 3 patients (9%) experienced a recurrence, Dr. Santos reported. However, Dr. Dietrich told this news agency that her fellow misspoke and that only two patients (5.8%) experienced a recurrence, one 2 months after surgery and one 2 years later. Only one patient underwent a repeat procedure, both women said.

“Labial hypertrophy can cause significant physical and social discomfort,” Dr. Santos concluded. “Providers should perform the technique which he or she is comfortable with and best suits the patient's anatomy.”

When asked by the audience how satisfaction was measured, Dr. Santos replied that they asked the patient if she was happy with the result. The audience also asked how compliance with postoperative care was measured, to which Dr. Santos replied that they assumed the patients were following instructions. Her responses failed to satisfy the audience, with an attendee suggesting that resolution of symptoms would have been a more rigorous clinical end point than overall satisfaction and cautioning the authors about making assumptions that can change clinical practice. Dr. Santos agreed that satisfaction is a complex construct to measure, and said they did ask patients whether their symptoms resolved.

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