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Laparoscopic management of Müllerian duct remnants in the paediatric age: Evidence and outcome analysis
Maja Raicevic1, Amulya Kumar Saxena2
1Department of Pediatric Surgery and Orthopedics, Clinical Center Nis, Serbia.
Insights
Laparoscopic management of Müllerian duct remnants (MDRs) is a safe and effective treatment. This approach shows low long-term morbidity, making it a viable option for pediatric surgical cases.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Genitourinary Surgery
Background:
- Müllerian duct remnants (MDRs) are congenital anomalies requiring surgical intervention.
- Laparoscopic techniques are increasingly utilized for pediatric surgical conditions.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic management for Müllerian duct remnants (MDRs).
- To assess the safety and efficacy of minimally invasive surgical approaches for MDRs.
Main Methods:
- A literature analysis was conducted, searching for studies on 'Müllerian' 'duct' 'remnants' and 'laparoscopy'.
- Primary endpoints included patient age at surgery, laparoscopic techniques employed, intraoperative complications, and postoperative morbidity.
Main Results:
- The analysis included 23 patients (mean age 1.5 years) from 10 articles (2003-2014).
- No intraoperative complications were reported. Postoperative morbidity included one case of prostatic diverticula.
- Common associations included hypospadias (13 patients) and cryptorchidism (6 patients).
Conclusions:
- Laparoscopic management of MDRs is an effective and safe treatment modality.
- The minimally invasive approach is associated with low long-term morbidity.
- Laparoscopic surgery offers a favorable option for pediatric patients with MDRs.
Background:
This study performed a literature analysis to determine outcomes of laparoscopic management in Müllerian duct remnants (MDRs).
Patients And Methods:
Literature was searched for terms 'Müllerian' 'duct' 'remnants' and 'laparoscopy'. Primary end points were age at surgery, laparoscopic technique, intraoperative complications and postoperative morbidity.
Results:
The search revealed 10 articles (2003-2014) and included 23 patients with mean age of 1.5 years (0.5-18) at surgery. All patients were 46XY, n = 1 normal male karyotype with two cell lines. Explorative laparoscopy was performed in n = 2 and surgical management in n = 21. The 5-port technique was used in n = 10, 3-port in n = 9 and robot-assisted laparoscopic approach in n = 1 (n = 1 technique not described). Complete MDRs removal in n = 9, complete dissection and MDRs neck ligation with endoscopic loops in n = 11 and n = 1 uterus and cervix were split in the midline. After MDRs removal, there were n = 2 bilateral orchidopexy, n = 3 unilateral orchidopexy, n = 1 Fowler-Stephens stage-I and n = 1 orchiectomy. Mean operative time was 193 min (120-334), and there were no intraoperative complications. Mean follow-up was 20.5 months (3-54) and morbidity included 1 prostatic diverticula. There were 13 associations with hypospadias, of which 3 had mixed gonads and 3 bilateral cryptorchidism. Other associations were unilateral cryptorchidism and incarcerated inguinal hernia n = 1, right renal agenesis and left hydronephrosis n = 1 and n = 2 with transverse testicular ectopy.
Conclusion:
This MDRs analysis suggests that the laparoscopic approach is an effective and safe method of treatment as no intraoperative complication has reported, and there is low morbidity in the long-term follow-up.
