The surgical treatment of cloaca

Similar to other anorectal malformations, cloaca also represents a spectrum of defects that goes from "benign" cloaca with a good functional prognosis that can be repaired with a relatively simple surgical technique, to very complex malformations with many anatomic variations that require different surgical maneuvers to be able to successfully reconstruct those patients. The group of patients born with a "benign" type of cloaca will have bowel and urinary control, will become sexually active and may get pregnant and deliver by cesarean section. All this is possible, provided the malformation is repaired with a meticulous and delicate technique. Fortunately this represents more than 50% of all cloacas. Our belief is that the surgical technique to repair this group of defects is reproducible and can be taught to pediatric surgical trainees. On the other hand, complex cloaca with a common channel longer than 3 cm should be repaired by surgeons fully dedicated to repair these malformations. The experience reported in this paper is based on 570 patients with cloaca operated by Dr. Alberto Peña and the author in the last 8 years.