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Abstract
The repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative complication seen after cloacal repair as reported in the literature. A systematic literature search was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Eight records were eligible for this study which were qualitatively analyzed according to the Rangel score. Overall complication rates reported in included studies ranged from 0 to 57 %. After meta-analysis of data, postoperative complications were seen in 99 of 327 patients (30 %). The most common reported complications were recurrent or persistent fistula (n = 29, 10 %) and rectal prolapse (n = 27, 10 %). In the PSARVUP group, the complication rate was 40 % and in the TUM group 30 % (p = 0.205). This systematic review shows that postoperative complications after cloacal repair are seen in 30 % of the patients. The complication rates after PSARVUP and TUM were not significantly different. Standardization in reporting of surgical complications would inform further development of surgical approaches. Other techniques aiming to lower postoperative complication rates may also deserve consideration.
Highlights
Patients with a congenital cloacal malformation undergo complex reconstruction of the rectourogenital tracts
This systematic review shows that postoperative complications after cloacal repair are seen in 30 % of the patients
With this systematic review including our own 25-year experience, we have demonstrated that complication rates after total urogenital mobilization (TUM) are slightly lower than after posterior sagittal anorecto-vaginourethroplasty (PSARVUP), the difference is not significant (p = 0.205)
Summary
Patients with a congenital cloacal malformation undergo complex reconstruction of the rectourogenital tracts. The current surgical approach for cloacal repair was derived from the posterior sagittal anorectoplasty (PSARP), described by Pena and De Vries [1, 2]. This posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) extended the anorectoplasty with a meticulous dissection of the combined vaginal–urethral walls, followed by the reconstruction of distal parts of both structures [3]. With or without the TUM, there was considerably less incontinence in the long term, but constipation or obstructive defecation became an increasingly serious problem [6]
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