Laparoscopic-assisted perineal pull-through vaginoplasty Ilhan Ciftci ⁎ Department of Pediatric Surgery, University of Selcuk, Selcuklu Medical Faculty, Konya, Turkey Received 13 June 2011; revised 12 October 2011; accepted 22 November 2011 Key words: Pull-through; Vaginoplasty; Laparoscopy; Child Abstract Hematometrocolpos is the result of vaginal obstruction and can become an emergency in the pubertal period. The treatment of imperforate hymen is well defined, but the treatment of vaginal atresia is more complex. We report a case of hematometrocolpos secondary to distal vaginal atresia that was operated on in the pubertal period. The patient had isolated distal atresia without persistence of the urogenital sinus. A combined abdominal laparoscopic and perineal approach and a posterior vaginoplasty were carried out. Finally, an abdominoperineal pull-through was successfully performed. Neovagina was successfully developed with this method. The embryology and literature are reviewed. The classification, indications, and surgical technique are discussed. We suggest that this procedure is suitable for patients with vaginal agenesis and a normal uterus. Published by Elsevier Inc. Vaginal agenesis is known as one of the Müllerian anomalies. Müllerian anomalies occur during gonadal develop- ment and differentiation, and may lead to complex outcomes. Possible reasons for these anomalies include cessation or regression of Müllerian duct development and deficiency of estrogen and gestagen receptors. This syndrome is frequently associated with malformations of the urinary tract and skeletal system, which are observed in 40% and 10% of cases, respectively. These findings suggest an embryological link between genitourinary and bone development. Familial cases have been reported, which supports the notion that this is an inherited syndrome, but with variable expression and reduced penetrance [1-3]. These anomalies usually manifest themselves in neonates and in young girls aged 9–15 years who have good secondary sexual development. Lower abdominal mass and tense bulging bluish membrane at introitus is the most common presentation. About 15% of cases of abdominal mass in newborn girls are due to hydrometrocolpos [4]. Respiratory distress due to enormous abdominal distension has been reported in neonates [4]. An over-distended vagina compresses the adjacent organs and can cause abdominal pain, intestinal obstruction, urethral obstruction, hydronephrosis, bladder perforation, and venous stasis in the lower extremities. Unusual presentations in adolescent girls include backache and acute abdomen mimicking acute appendicitis [5]. In such cases, hematometrocolpos is suspected first, due to the absence of distal extension. Ultrasound and magnetic resonance imaging and laparoscopy modalities provide useful information [6]. Distal vaginal agenesis is a urogenital sinus anomaly which is rarely isolated. Our patient was one of those uncommon cases. 1. Case report A 13-year-old girl presented to the emergency depart- ment with cyclic abdominal pain. Initial examination revealed an intraabdominal 10-cm mass. She was subse- quently referred to our clinic. On obtaining a medical ⁎ Selcuk Universitesi Selcuklu Tip Fakultesi, Cocuk Cerrahisi A. D. Konya, Turkey. Tel.: +90 3322415000; fax: +90 3322412184. E-mail address: driciftci@hotmail.com. www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter. Published by Elsevier Inc. doi:10.1016/j.jpedsurg.2011.11.070 Journal of Pediatric Surgery (2012) 47, E13–E15