Pediatric Surgery International

, Volume 27, Issue 5, pp 505–508 | Cite as

Therapeutic strategy for persistent cloaca: the efficacy of antegrade continent enema as a salvage surgery

  • Akio Kubota
  • Keigo Nara
  • Hisayoshi Kawahara
  • Akihiro Yoneda
  • Hiroshi Nakai
  • Taro Goda
  • Soji Ibuka
  • Futoshi Matsui
  • Kenji Shimada
Original Article

Abstract

Purpose

The aim of this study is to evaluate our therapeutic strategy for persistent cloaca from the viewpoint of long-term functional outcome.

Materials and methods

This study covers 17 cases of persistent cloaca treated at our institution and followed for more than 3 years. As a definitive repair for anorectal and urogenital systems, simultaneous surgery with posterior sagittal approach or anorecto-urethrovagino-plasty (PSARUVP) was performed. The length of the common channel and the shape of the vagina determined the vaginoplasty methods. Fecal function was assessed with the scoring system of the Japan Study Group of Anorectal Anomalies.

Results

Anorectoplasty was performed with the posterior sagittal approach in 15 cases and with the perineal approach in two. Vaginoplasty was performed with total urogenital mobilization in nine cases, rectal interposition in four, vaginal flap in two and with other methods. Fecal function was classified as good in three cases, moderate in ten, and poor in four. In the poor cases, Malone’s antegrade continence enema (MACE) was performed, which improved fecal function significantly.

Conclusion

PSARUVP might be the optimal surgery for persistent cloaca at present; however, satisfactory fecal function could not be achieved in those cases with a longer common channel. MACE effectively compensated for the poor outcome and was especially successful at eliminating incontinence.

Keywords

Persistent cloaca Anorectoplasty Vaginoplasty Posterior sagittal approach Anorecto-urethrovagino-plasty Antegrade continence enema 

References

  1. 1.
    Pena A, De Vries P (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811PubMedCrossRefGoogle Scholar
  2. 2.
    Pena A (1997) Total urogenital mobilization—an easier way to repair cloacas. J Pediatr Surg 32:263–267PubMedCrossRefGoogle Scholar
  3. 3.
    Hendren WH (1986) Repair of cloacal anomalies: current techniques. J Pediatr Surg 21:1159–1176PubMedCrossRefGoogle Scholar
  4. 4.
    Pena A (1989) The surgical management of persistent cloaca: results in 54 patients treated with a posterior sagittal approach. J Pediatr Surg 24:590–598PubMedCrossRefGoogle Scholar
  5. 5.
    Shimada K, Hosokawa S, Matsumoto F, Johnin K, Naitoh Y, Harada Y (2001) Urogenital management of cloacal anomalies. Int J Urol 8:282–289PubMedCrossRefGoogle Scholar
  6. 6.
    Kayaba H, Hebiguchi T, Yoshino H, Mizuno M, Yamada M, Chihara J, Kato T (2002) Evaluation of anorectal functions of children with anorectal malformations using fecoflowmetry. J Pediatr Surg 37:623–628PubMedCrossRefGoogle Scholar
  7. 7.
    Malone PS, Ransley PG, Kiely EM (1990) Preliminary report the antegrade continence enema. Lancet 336:1217–1218PubMedCrossRefGoogle Scholar
  8. 8.
    Tam PKH (1999) Y-appendicoplasty: a technique to minimize stomal complications in antegrade continence enema. J Pediatr Surg 34:1733–1736PubMedCrossRefGoogle Scholar
  9. 9.
    Matsui F, Shimada K, Matsumoto F, Obara T, Kubota A (2009) Bladder function after total urogenital mobilization for persistent cloaca. J Urol 182:2455–2459PubMedCrossRefGoogle Scholar
  10. 10.
    Hendren WH (1998) Cloaca, the most severe degree of imperforate anus: experience with 195 cases. Ann Surg 228:331–346PubMedCrossRefGoogle Scholar
  11. 11.
    Pena A, Levitt MA, Hong A, Midulla P (2004) Surgical management of cloacal malformations: a review of 339 patients. J Pediatr Surg 39:470–479PubMedCrossRefGoogle Scholar
  12. 12.
    Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-though for high imperforate anus—a new technique. J Pediatr Surg 35:927–931PubMedCrossRefGoogle Scholar
  13. 13.
    Tei E, Yamataka A, Segawa O, Kobayashi H, Lane GL, Tobayama S, Kaneoka S, Miyano T (2003) Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations. J Pediatr Surg 38:1770–1774PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Akio Kubota
    • 1
  • Keigo Nara
    • 1
  • Hisayoshi Kawahara
    • 1
  • Akihiro Yoneda
    • 1
  • Hiroshi Nakai
    • 1
  • Taro Goda
    • 1
  • Soji Ibuka
    • 1
  • Futoshi Matsui
    • 2
  • Kenji Shimada
    • 2
  1. 1.Department of Pediatric SurgeryOsaka Medical Center and Research Institute for Maternal and Child HealthIzumiJapan
  2. 2.Department of Pediatric UrologyOsaka Medical Center and Research Institute for Maternal and Child HealthIzumiJapan

Personalised recommendations