Surgical Treatment of Cloacas

Prior to undertaking the repair of cloacal malformations, the surgeon should perform endoscopy to determine the length of the common channel. There are two well-characterized groups of patients with cloaca

High Cloaca
Fig. 22.1 Spectrum of cloacae. A Most common channel. B Long common channel ([6], with permission)

Fig. 22.2 Spectrum of cloacae. A High rectal implantation into the vagina. B Short common channel ([6], with permission)

Fig. 22.3 A Associated hydrocol-pos. B Double vagina and double uterus ([6], with permission)

Fig. 22.4 Cloaca repair. A Incision. B Rectum and common channel are exposed. C Rectal opening ([6], with permission)

[4], and each represent different technical challenges that must be recognized preoperatively.

The first is represented by patients who are born with a common channel shorter than 3 cm. Fortunately, these patients represent the majority (over 60%) of all cloacas. The great majority of these patients can be repaired using only a posterior sagittal approach, without a laparotomy, and the operation is a reproducible one that can be performed by most general pediatric surgeons.

The second group is represented by patients with longer common channels. These patients usually need a laparotomy and a decision-making algorithm for the reconstruction that requires a large experience and special training in urology. These patients are therefore best cared for in centers with special expertise in the repair of these defects.

Cloaca With Double Uterus
Fig. 22.5 Total urogenital mobilization. The rectum is separated from the vagina ([7], with permission)

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