Cloacal exstrophy--pull-through or permanent stoma? A review of 53 patients

Journal of Pediatric Surgery
M A LevittA Peña

Abstract

Patients with cloacal exstrophy have complex anomalies of the genitourinary and gastrointestinal tract with a spectrum of colonic length. Often, colon is lost during the initial management by use of ileostomies and for urologic and genital reconstruction. It is a common belief that these patients require permanent stomas, which we hypothesized is inaccurate, and therefore reviewed our experience with exstrophy, focusing specifically on a patient's potential to undergo a colonic pull-through. All patients with exstrophy or exstrophy variant treated by the authors were retrospectively reviewed. Their ability to form solid stool was assessed via bowel management involving a constipating diet, antidiarrheals, bulking agents, and a daily enema through the stoma. Patients who underwent successful bowel management through the stoma were offered a pull-through. Fifty-three patients were treated over a 26-year period, including typical cloacal exstrophy (27), or a covered variant (16), and complex anorectal malformations with short colon (10). Newborn operations (48 done at other institutions, 5 by us) involved ileostomy in 11 or end colostomy in 42. Eight patients with ileostomies suffered acidosis and failure to thrive and underwent "...Continue Reading

References

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Citations

Oct 16, 2009·Pediatric Surgery International·Andrea BischoffAlberto Peña
Aug 11, 2012·Pediatric Surgery International·Andrea BischoffAlberto Peña
Mar 3, 2010·Pediatrics in Review·Marc A Levitt, Alberto Peña
May 13, 2014·Pediatric Surgery International·Andrea BischoffAlberto Peña
Apr 2, 2011·Seminars in Pediatric Surgery·David Sawaya, John P Gearhart
Mar 24, 2010·Seminars in Pediatric Surgery·Andrea Bischoff, Manuel Tovilla
Nov 17, 2009·The Journal of Urology·Shumyle Alam, Eugene Minevich
Nov 17, 2009·The Journal of Urology·Christopher C RothBradley P Kropp
Jun 16, 2009·Journal of Pediatric Surgery·Andrea BischoffAlberto Peña
May 25, 2021·European Journal of Pediatric Surgery Reports·Caitlin A SmithMarc Levitt
Jan 23, 2009·Journal of Pediatric Surgery·Frederick J Rescorla

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