Laparoscopic management of Müllerian duct remnants in the paediatric age: Evidence and outcome analysis.

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.