EFFECTIVENESS OF POSTERIOR SAGITTAL ANORECTOPLASTY AND TOTAL UROGENITAL MOBILIZATION IN TREATMENT OF CLOACAL MALFORMATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGGang , JIANGWenjun , WANGXuejun ,  LIUWenying

Department of Pediatric Surgery, Center of Children Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P. R. China;

Corresponding?author：

LIUWenying, Email: wenyingl@126.com

Keywords：

Cloacal malformation; Posterior sagittal approach; Anorectoplasty; Total urogenital mobilization

DOI：

10.7507/1002-1892.20140080

Video：

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Objective To investigate the effectiveness of posterior sagittal anorectoplasty (PSARP) and total urogenital mobilization in treatment of cloacal malformation. Methods Three girls with cloacal malformation were admitted between June 2010 and June 2013. The age was 2 years, 5 months, and 4 months, respectively. All patients received previous separated sigmoid colostomy. PSARP and total urogenital mobilization were performed to correct the malformation. Colostomy stoma was closed after confirming the patent of rectum and anus. Dilation of anus was sustained for 6 months after anorectoplasty. Results Operations were successfully completed in 3 cases. The durations of operation were 3 hours and 40 minutes, 4 hours and 20 minutes, and 3 hours and 50 minutes; the blood loss was 10, 20, and 10 mL; and the time of colostomy stoma closure was 3, 5, and 3 months, respectively. Three cases were followed up 13, 18, and 4 months, respectively; no anal stenosis or rectal prolapse occurred. They had normal micturition; the B ultrasonic examination showed that the residual urine volume was less than 10 mL. At 12 months after anorectoplasty, the Wexner scores were 1 and 5 in 2 cases followed up 13 and 18 months; according to Krickenbeck postoperative effect, 2 cases had defecation and no constipation; 1 case had soiling (grade 1). Conclusion PSARP and total urogenital mobilization should be the first choice in treatment of cloacal malformation with common channel less than 3 cm.

Citation： YANGGang, JIANGWenjun, WANGXuejun, LIUWenying. EFFECTIVENESS OF POSTERIOR SAGITTAL ANORECTOPLASTY AND TOTAL UROGENITAL MOBILIZATION IN TREATMENT OF CLOACAL MALFORMATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 358-361. doi: 10.7507/1002-1892.20140080 Copy

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3.	吳曄明. 尿道陰道整體拖出術治療嬰兒一穴肛畸形. 臨床小兒外科雜志, 2010, 9(2):145-146.
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6.	Demirogullari B, Ozen IO, Karabulut R, et al. Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus. J Pediatr Surg, 2008, 43(10):1839-1843.
7.	鄭珊, 張培, 董巋然, 等. 先天性肛門直腸畸形肛門成形術后再手術的臨床分析. 中華小兒外科雜志, 2012, 33(4):296-299.
8.	B?l?nescu RN, Topor L, Moga A. Anomalies associated with anorectal malformations. Chirurgia (Bucur), 2013, 108(1):38-42.
9.	Hendren WH. Repair of cloacal anomalies:current techniques. J Pediatr Surg, 1986, 21(12):1159-1176.
10.	馬繼東, 葉蓁蓁, 張小倫, 等. 泄殖腔整體游離術治療低位一穴肛二例報告. 中華小兒外科雜志, 2002, 23(6):520-522.
11.	Pe?a A, Levitt MA, Hong A, et al. Surgical management of cloacal malformations:a review of 339 patients. J Pediatr Surg, 2004, 39(3):470-479.
12.	Bischoff A, Levitt MA, Breech L, et al. Hydrocolpos in cloacal malformations. J Pediatr Surg, 2010, 45(6):1241-1245.
13.	Breech L. Gynecologic concerns in patients with anorectal malformations. Semin Pediatr Surg, 2010, 19(2):139-145.
14.	Coran AG, Adzick NS, Krummel TM, et al. Pediatric Surgery. 7th ed. St Louis:Mosby-Elsevier, 2012:1289-1309.
15.	Levitt MA, Pe?a A. Cloacal malformations:lessons learned from 490 cases. Semin Pediatr Surg, 2010, 19(2):128-138.
16.	Warne SA, Hiorns MP, Curry J, et al. Understanding cloacal anomalies. Arch Dis Child, 2011, 96(11):1072-1076.
17.	Fabbro MA, Chiarenza F, D'Agostino S, et al. Anorectal malformations (ARM):quality of life assessed in the functional, urologic and neurologic short and long term follow-up. Pediatr Med Chir, 2011, 33(4):182-192.

1. Iwai N, Fumino S. Surgical treatment of anorectal malformations. Surg Today, 2013, 43(9):955-962.
2. 張小康, 黃金獅, 陶強, 等. 一穴肛2例報告并文獻復習. 臨床小兒外科雜志, 2013, 12(2):159-160.
3. 吳曄明. 尿道陰道整體拖出術治療嬰兒一穴肛畸形. 臨床小兒外科雜志, 2010, 9(2):145-146.
4. Pe?a A. Total urogenital mobilization-an easier way to repair cloacas. J Pediatr Surg, 1997, 32(2):263-268.
5. Sansoni J, Hawthorne G, Fleming G, et al. The revised faecal incontinence scale:a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum, 2013, 56(5):652-659.
6. Demirogullari B, Ozen IO, Karabulut R, et al. Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus. J Pediatr Surg, 2008, 43(10):1839-1843.
7. 鄭珊, 張培, 董巋然, 等. 先天性肛門直腸畸形肛門成形術后再手術的臨床分析. 中華小兒外科雜志, 2012, 33(4):296-299.
8. B?l?nescu RN, Topor L, Moga A. Anomalies associated with anorectal malformations. Chirurgia (Bucur), 2013, 108(1):38-42.
9. Hendren WH. Repair of cloacal anomalies:current techniques. J Pediatr Surg, 1986, 21(12):1159-1176.
10. 馬繼東, 葉蓁蓁, 張小倫, 等. 泄殖腔整體游離術治療低位一穴肛二例報告. 中華小兒外科雜志, 2002, 23(6):520-522.
11. Pe?a A, Levitt MA, Hong A, et al. Surgical management of cloacal malformations:a review of 339 patients. J Pediatr Surg, 2004, 39(3):470-479.
12. Bischoff A, Levitt MA, Breech L, et al. Hydrocolpos in cloacal malformations. J Pediatr Surg, 2010, 45(6):1241-1245.
13. Breech L. Gynecologic concerns in patients with anorectal malformations. Semin Pediatr Surg, 2010, 19(2):139-145.
14. Coran AG, Adzick NS, Krummel TM, et al. Pediatric Surgery. 7th ed. St Louis:Mosby-Elsevier, 2012:1289-1309.
15. Levitt MA, Pe?a A. Cloacal malformations:lessons learned from 490 cases. Semin Pediatr Surg, 2010, 19(2):128-138.
16. Warne SA, Hiorns MP, Curry J, et al. Understanding cloacal anomalies. Arch Dis Child, 2011, 96(11):1072-1076.
17. Fabbro MA, Chiarenza F, D'Agostino S, et al. Anorectal malformations (ARM):quality of life assessed in the functional, urologic and neurologic short and long term follow-up. Pediatr Med Chir, 2011, 33(4):182-192.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF POSTERIOR SAGITTAL ANORECTOPLASTY AND TOTAL UROGENITAL MOBILIZATION IN TREATMENT OF CLOACAL MALFORMATION

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