[Surgical management of cloacal malformations]

Cloaca is a defect in which the rectum, the vagina and the uretra are fused in a single common channel. Cloaca is the most complex anorectal malformation. The surgical management depends on the length of the common channel and the associated defects.

Since 1993 we have treated 9 cases of cloacas. The average age at surgery was 12 months. Five patients had associated vertebral defects, six had urological defects and six had vaginal defects. All patients were approached posterior sagitally; 4 of them also required a laparotomy.

Five patients underwent a total urogenital mobilization. In the four patients requiring laparotomy we performed vaginal switch in 1, and vaginal replacement in 3 (2 with ileum and 1 with colon). Six patients are older than four and have fecal continence. Three of them are continent of urine, and 1 remains dry with intermittent catheterization. Two patients remain derivated (ureterostomy, vesicostomy).

Surgical repair should be completed early, and it should include cystoscopy, posterior sagital approach, and laparotomy depending on the complexity of the defect. Cloaca is a challenge for the surgeon because of the wide spectrum of anatomic defects and the need to apply different surgical techniques in order to achieve good functional and cosmetic results.