Role of laparoscopy in vaginal malformation

BACKGROUND: The aim of this study was to assess the role of laparoscopy in the management of vaginal malformations in children, a subject not often discussed in the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal malformations. Two main patient populations were distinguished: younger children with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with hematocolpos. A third of the malformations were identified on systematic clinic examination, a third on the basis of abdominal pain, and a third due to various other symptoms. Nine of the girls had associated malformations of the uterus, external genital organs, or urinary tract. Eight patients underwent laparoscopy, either to look for endometriosis in cases of hematocolpos, to make an accurate determination of malformations in cases where clinical and paraclinical methods failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were performed in eight patients. Three diagnostic laparoscopies enabled us to determine the exact nature of the malformations. One newborn underwent two laparoscopic procedures to treat peritoneal fibrous bands that had caused repeated episodes of obstruction. Six patients underwent exploratory laparoscopy to look for endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied systematically in the management of any malformation, but it can be useful when complementary exams fail to make an accurate diagnosis of the anomaly or for the management of the rare complication of adhesions and bands. When used to search for endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still appropriate for that purpose. However, the optimal timing of the procedure still needs to be established.