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Single-Stage Surgery for Persistent Cloaca With Vertebral Defects, Anal Atresia, Cardiac Defects, Tracheoesophageal
Takayuki Masuko1, Toshihiro Yanai2, Miki Toma2
1Pediatric Urology, Ibaraki Children's Hospital, Ibaraki, JPN.
Insights
This study presents a novel approach for managing persistent cloaca (PC) in VACTERL association patients, avoiding temporary colostomy. A single-stage laparoscopic repair was successful, reducing surgical burden.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Urology
Background:
- Persistent cloaca (PC) in VACTERL association often necessitates a multi-stage surgical approach, including initial colostomy.
- The conventional management involves multiple laparotomies, increasing surgical complexity and patient morbidity.
Observation:
- This study details two cases of PC with VACTERL association managed without a temporary colostomy.
- A continuous transanal drainage system was employed for bowel decompression prior to definitive repair.
Findings:
- Both patients successfully underwent a single-stage laparoscopic anorectoplasty and perineal urogenital mobilization.
- No major complications like enterocolitis or urinary tract infections were observed, challenging the necessity of a preliminary colostomy.
Implications:
- This single-stage approach without colostomy may be a viable alternative for selected PC patients with VACTERL association.
- Minimizing surgical interventions could lead to improved patient outcomes and reduced healthcare costs.
- Further research is warranted to establish the safety and efficacy of this approach in a larger cohort.
Abstract:
The standard treatment for persistent cloaca (PC) in patients with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula or atresia, renal anomalies, and limb defects (VACTERL) association typically involves an initial colostomy to decompress the intestine and prevent urinary tract infections. However, patients with VACTERL association often require multiple surgeries, including gastrostomy for esophageal atresia, open-heart surgery, and spinal surgery requiring a prone position, which can complicate subsequent procedures. Here, we describe two cases of PC with VACTERL association successfully managed without a temporary colostomy until definitive surgery. Instead of a colostomy, a continuous transanal drainage system was used for bowel decompression. Both patients underwent single-stage laparoscopic anorectoplasty and perineal urogenital mobilization without major complications such as enterocolitis or urinary tract infections. The conventional approach to PC typically requires three laparotomies: colostomy, definitive repair, and colostomy closure. Our experience suggests that, in selected cases, a single-stage surgical approach without a temporary colostomy may offer a feasible alternative in appropriately selected cases.
