Should pull through be offered to patients with cloacal exstrophy?

Worldwide, pull through is uncommon in patients with cloacal exstrophy due to heterogeneous outcomes, however it is frequently performed at our center. We characterized this population and their longitudinal outcomes.

A review of a prospectively maintained database (1981-present) of patients with cloacal exstrophy was conducted, noting demographics, associated anomalies, surgical history, and outcomes at most recent follow up.

There were 91 patients with cloacal exstrophy (67 classic, 24 covered). Pull through, offered based on trial of bowel management through the stoma, was performed in 58 patients (63.7%) at median age 2.46 years (IQR 1.44, 5.08). The most frequent reasons to not undergo pull through were failed stoma bowel management (39.4%) and patient/family preference (33.3%). Outcomes, assessed at median 4.84 years post pull through, were reported in 40/58 patients, among which 36 were clean for stool or continent and 4 patients underwent reversal.

With preservation of colon and incorporation into the gastrointestinal tract at initial operation, followed by successful bowel management through the stoma, a pull through was performed in 63.7% of patients. Candidacy for pull through should be assessed, ideally prior to, or concurrent with, bladder reconstruction.