A. F. Doval1, B. N. Tran1, B. T. Lee1, O. Ganor2 1Beth Israel Deaconess Medical Center,Plastic And Reconstructive Surgery,Boston, MA, USA 2Boston’s Children Hospital,Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: Infants with a congenital discrepancy between external genitalia, gonadal, and chromosomal sex are classified as having a disorder of sexual development. The most common form of DSD with atypical genitalia is 46 XX with congenital adrenal hyperplasia; as such feminizing genitoplasty is the standard surgical correction. We examined the trends and outcomes of atypical genitalia surgery for DSD in pediatric population using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
Methods: Infants with DSD were identified from NSQIP 2012-2015 using ICD 9 and 10 codes. Descriptive data about patients’ demographics, types of procedures, surgical specialty performing the surgery, and perioperative complications including bleeding, infection, wound dehiscence, unplanned reoperation, unplanned intubation, and readmission were obtained.
Results: 46 cases of DSD were identified. Most surgical correction occurred at 3-4 years of age in genetically female patients (65%). Types of reconstructive surgery included feminizing procedures (45.7% including vaginoplasty, clitoroplasty), masculinizing procedures (28.3% including laparoscopic procedure on testis, laparoscopic vaginal hysterectomy, penile repair, vaginectomy, laparoscopic TAH-BSO), or undetermined (26% including adjacent diagnostic laparoscopy, tissue transfer, excision of penile lesions, and enterostomy and external fistulization of intestines). Postoperative complications detailed 2 incidences of bleeding requiring transfusion, 1 of unplanned intubation, and 1 of prolonged hospitalization.
Conclusion: This study reaffirms the rising awareness of surgical intervention for disorders of sexual development. Most patients were genetically female with congenital adrenal hyperplasia and the most common reconstructive surgery was feminizing genitoplasty. Interestingly, the mean age of reconstruction reflected early genital surgery. Postoperative complications showed that atypical genitalia surgery is safe for pediatric population.
