Outcomes From Colonic Pull-Through for Cloacal Exstrophy Differ by Colon Length: A Multi-Institutional Study.
Document Type
Article
Publication Date
2-2024
Identifier
DOI: 10.1016/j.jpedsurg.2023.10.019
Abstract
BACKGROUND: Cloacal exstrophy (CE) represents a rare sub-group of anorectal malformations. Traditionally managed with a permanent colostomy, colonic pull-through (PT) has emerged to allow cleanliness without a life-long stoma. We sought to understand outcomes of PT in a large multi-center CE population.
METHODS: We performed a retrospective study involving eleven pediatric hospitals. We gathered data on demographics, outcomes, and anatomical factors including colon length. Continuous variables were analyzed with Wilcoxon rank-sum tests and categorial variables with Fisher's exact tests.
RESULTS: There were 98 patients, of which the majority (n = 70, 71.4 %) never underwent PT. There were no differences in exstrophy type, demographics, or associated anomalies. Median age at PT was 1.3 years (IQR 0.3-3.7). Of the cohort that continue to use their PT, the majority (n = 16, 69.6 %) are not clean. In total, 7.1 % (n = 7) of the cohort is clean with a PT, and only one patient is continent. Clean patients have a longer colon length than those who are not clean or opt for re-do ostomy (64.0 cm [IQR 46.0-82.0] vs 26.5 cm [IQR 11.6-41.2], p = 0.005).
CONCLUSION: Overall, we demonstrate that most children born with CE will keep their stoma. Only a small percentage who elect to undergo colonic PT are clean for stool. Greater colon length correlates with success. This suggests that multiple factors, including colon length, are important when considering PT in a child with CE.
LEVEL OF EVIDENCE: III.
Journal Title
Journal of pediatric surgery
Volume
59
Issue
2
First Page
225
Last Page
229
MeSH Keywords
Child; Humans; Infant; Child, Preschool; Anorectal Malformations; Retrospective Studies; Bladder Exstrophy; Colostomy; Colon
Keywords
Anorectal malformation; Continence; Ostomy; Surgical outcomes
Recommended Citation
Srinivas S, Knaus ME, Avansino JR, et al. Outcomes From Colonic Pull-Through for Cloacal Exstrophy Differ by Colon Length: A Multi-Institutional Study. J Pediatr Surg. 2024;59(2):225-229. doi:10.1016/j.jpedsurg.2023.10.019
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