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Outcomes From Colonic Pull-Through for Cloacal Exstrophy Differ by Colon Length: A Multi-Institutional Study. J Pediatr Surg 2024 Feb;59(2):225-229

Date

11/16/2023

Pubmed ID

37968156

DOI

10.1016/j.jpedsurg.2023.10.019

Scopus ID

2-s2.0-85176382469 (requires institutional sign-in at Scopus site)

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.

Author List

Srinivas S, Knaus ME, Avansino JR, Badillo A, Calkins CM, Dickie BH, Durham MM, Fuller MK, Ralls MW, Reeder RW, Rentea RM, Rollins MD, van Leeuwen K, Wood RJ, Pediatric Colorectal and Pelvic Learning Consortium

Author

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anorectal Malformations
Bladder Exstrophy
Child, Preschool
Colon
Colostomy
Humans
Infant
Retrospective Studies