Presenter: Brian P Fallon, MD
CLOACA REPAIR WITH IMAGE-GUIDED AND COMBINED ENDOSCOPIC AND LAPAROSCOPIC (CELS) ANORECTOPLASTY WITH DELAYED UROGENITAL RECONSTRUCTION
Brian P Fallon, MD1; Marcus D Jarboe, MD1; Bryan S Sack, MD2; Elisabeth H Quint, MD3; Matthew W Ralls, MD1; 1Section of Pediatric Surgery, Department of Surgery, University of Michigan; 2Department of Urology, University of Michigan; 3Department of Obstetrics and Gynecology, University of Michigan
Traditionally, cloaca is repaired through an open posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) and abdominal mobilization. Despite years of developing this technique, functional outcomes remain poor, including obstructed menstruation in 38% of patients and amenorrhea in 25%. This video presents an alternative operative strategy with delayed urogenital reconstruction. This muscle-sparing approach begins with real-time MRI-guided needle placement through the anal sphincter complex and levator ani, followed by combined endoscopic and laparoscopic (CELS) rectal mobilization, and finally anorectal pull-through. The patient in this video was born with persistent cloaca with no cervical os identified, no hydrocolpos, and normal bladder capacity. The patient’s family was counseled by Pediatric Urology, Adolescent Gynecology, and Pediatric Surgery. They elected to delay urogenital reconstruction and proceed with the above-described anorectoplasty. With appropriate patient selection, this technique addresses fecal diversion only with urogenital reconstruction delayed to an age where the patient can actively participate in shared decision making.