Individualized evaluations and surgical options of cloacal malformations

Abstract

Objective To explore the individualized preoperative evaluations of cloacal malformations and to examine its guiding significance for surgical approaches. Methods A retrospective analysis was conducted for clinical data from 31 girls with cloaca malformations from March 2011 to November 2017. During the first and second assessments prior to palliative and radical operations, clinical significance was analyzed for urinary and reproductive system malformations, rectal position and common channel length by ultrasonography type B, common channel angiography, magnetic resonance (MR) and endoscopy, abnormality type and selecting surgical approaches. Initial visit was (280.25±731.01) days with an age range of (0-9) years (median: 25 days); the follow-up period (51.91±44.13) months with a median range of 41(11-192) months. Results Ten patients (type I) with a common canal 1 cm and 3 cm high malformation (n=7). The procedures of type I malformation included posterior sagittal anorectoplasty (PSARP)(n=3) and PSARP plus post-vaginal wall mobilization (n=7); all cases with low malformation had PSARP plus urogenital sinus mobilization (n=14). One patient underwent PSARP with untreated urogenital sinus while another 6 girls had rectal vaginal replacement plus angioplasty. During a follow-up period of 38.46(9-84) months, there were perineal wound rupture (n=1) and vaginal/anal stenosis (n=4). The overall prognosis was good after corresponding treatments. Conclusions With the guidance of the first and second evaluation strategies, individualized assessment based upon common canal angiography, CT, MR and endoscopy can identify the associated malformations, complete the individualized assessments of common channels and effectively guide the choice of surgical approaches. Key words: Individualized medicine; Congenital ano-rectal malformation; Cloaca deformity