Abstract

Objectives: This study aimed to compare recurrence following manual separation between two maintenance protocols, topical antibiotic alone versus antibiotic plus estrogen, and to evaluate additional risk factors associated with recurrence.

Patients and methods: This retrospective study was conducted by reviewing the medical records of pediatric patients presenting with labial synechia at two pediatric surgery centers between January 1, 2023, and December 15, 2025. Each center used one maintenance protocol (Center 1: antibiotic plus estrogen, n = 73; Center 2: antibiotic alone, n = 68), so protocol and center are completely collinear. All patients were followed for at least six months; recurrence was defined as re-approximation of ≥ 25% of the labial length. Firth penalized regression was used.

Results: A total of 141 female patients (median age: 1 year [IQR, 0-2 years]; range, 0 to 10 years) who underwent manual separation for labial synechia were analyzed. Recurrence developed in 30 of 141 patients (21.3%; mean 10.20 ± 8.10 weeks): 19.2% with the combined protocol and 23.5% with antibiotics alone (risk difference −4.4 points, 95% CI: −17.9 to 9.1; p = 0.528; adjusted odds ratio 0.38, 95% CI: 0.12-1.04). Recurrence was more frequent with fibrotic than thin adhesions (90.9% vs. 15.4%; risk ratio 5.91, 95% CI: 3.54-9.15; p < 0.001) and in both symptomatic patients (p = 0.044); fibrotic adhesion remained the strongest correlate after adjustment (adjusted odds ratio 63.40, 95% CI: 11.12-757.06). After repeat separation plus combined therapy, 27 of 30 did not recur.

Conclusion: Manual separation is an effective and rapid primary intervention. Recurrence did not differ significantly between the two protocols, and no adverse effect was seen with either; as the protocol was determined by the center, no superiority can be inferred, though both appear acceptable. Fibrotic adhesions warrant close follow-up.

Citation: Bilaloğlu E, Külice EC. Recurrence after manual separation for labial synechia in prepubertal girls: A two-center retrospective cohort study with center-specific maintenance protocols. Turkish J Ped Surg 2026;40(3):147-158. doi: 10.62114/ JTAPS.2026.277.