Restoring hindgut continuity in cloacal exstrophy: a valuable method of optimising bowel length

In cloacal exstrophy the hindgut is typically a blind ending segment attached to the exstrophy plate. This section of bowel may be mobilized, its continuity restored with the rest of the bowel, and used to fashion an end colostomy. We review our results using this approach.

A retrospective review of the outcomes was carried out on the basis of the case notes of nine consecutive patients with cloacal exstrophy who had been treated by restoration of hindgut continuity and an end colostomy.

The colostomy was fashioned at a median age of 17 days of life. The colostomy was formed as part of the primary repair in all but one patient in whom it was performed as a secondary procedure to treat a previously repaired, dehisced exstrophy repair where the hindgut had originally been left in situ. Seven patients had co-existing spinal anomalies and potentially neuropathic bowel. The median length of hindgut that was restored was 10 cm. Median interval until the stoma produced faeces was six days. There was stoma necrosis in one patient requiring early revision. Six patients underwent further subsequent bowel operations at a median interval of 9.1 months: four had colostomy revision but kept the hindgut, one had excision of the hindgut and a terminal ileostomy, and one had a pull-through operation that was subsequently further revised to an ileostomy.

Use of the hindgut loop in cloacal exstrophy to form a distal terminal colostomy is effective. Although stoma complications are common, these may be offset against the benefits of: restoration of hindgut electrolyte and fluid absorption; easier to mange stoma effluent; and the siting of the stoma on the left providing greater flexibility for future bladder reconstruction.