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
Fig. 22.2 Spectrum of cloacae. A High rectal implantation into the vagina. B Short common channel (, with permission)
Fig. 22.3 A Associated hydrocol-pos. B Double vagina and double uterus (, with permission)
Fig. 22.4 Cloaca repair. A Incision. B Rectum and common channel are exposed. C Rectal opening (, with permission)
, 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.
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