Single-port laparoscopic assisted ileal vaginal replacement for the management of Cloaca: A Novel approach

Reconstructing a cloaca with a common channel ≥3 cm, accompanied by a short urethra and poor vaginal development, presents significant challenges. In cases in which patients also have colon dysplasia, ileal vaginal replacement may be the only viable option. Traditionally performed via laparotomy, we present an initial series of single-port laparoscopic-assisted ileal vaginal replacement (SLIVR) and report the preliminary results.

Patients who underwent SLIVR between November 1, 2021, and October 1, 2023, were retrospectively reviewed. Data, including the demographic characteristics and clinical presentations of all four patients, were reviewed retrospectively. Patients were clinically followed-up for at least 6 months, and outcomes, including length of stay (LOS), operation time, amount of blood loss, and postoperative complications, were documented.

Four female patients meeting the surgical indications underwent SLIVR between November 1, 2021, and October 1, 2023. The age at the time of surgery ranged from 7 to 8 months, and the body weight ranged from 7.0 to 10.2 kg. The sacral ratio varied from 0.28 to 0.75. The operations lasted from 430 to 615 min, with blood loss ranging from 10 to 20 ml, and length of stay varying from 10 to 22 days. One patient experienced anal stenosis due to ileal ischemia and two episodes of hemorrhagic colitis.

Single-port laparoscopic-assisted ileal vaginal replacement offers surgeons a cosmetically appealing and minimally invasive approach to address this challenging condition.