Application of a continent fecal reservoir in patients with cloacal exstrophy.
OBJECTIVE
Initial enteric diversion in cloacal exstrophy is achieved by ileostomy or end colostomy with formal reconstruction in the form of hindgut pull-through performed in select patients. Those who are not candidates for a pull-through procedure are often left with a permanent incontinent stoma. Additionally due to congenitally deficient intestinal length, some patients with cloacal exstrophy experience short bowel syndrome. We present our surgical technique and clinical experience in 2 patients who were successfully treated with a novel continent cutaneous fecal reservoir.


METHODS
We devised a fecal reservoir in 2 patients with end ileostomies who were deemed poor candidates for pull-through of the hindgut segment. One of the patients exhibited short bowel syndrome before undergoing reconstruction. A continent cutaneous fecal reservoir was created from all available hindgut and a segment of ileum. A flap valve mechanism was used to create a continent catheterizable channel.


RESULTS
Seven years postoperatively both patients are continent of stool and neither has experienced complications attributable to enteric diversion. The patient with short bowel syndrome demonstrated significant improvement in nutritional status as evidenced by rapid weight gain and improvement in serum albumin level. Both patients and their families are highly satisfied with the surgical outcome.


CONCLUSIONS
Hindgut and ileum can be combined to create a novel continent fecal reservoir. As an alternative to diverting ileostomy or colostomy, continent diversion offers potential metabolic and social advantages. Select patients with cloacal exstrophy will benefit from this form of enteric reconstruction.
Roth
Christopher C
CC
Department of Urology, Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. christopher-roth@ouhsc.edu
Wilson
Bradley A
BA
Kibar
Yusuf
Y
Frimberger
Dominic
D
Kropp
Bradley P
BP
D002648:Child; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D039021:Colonic Pouches; D013505:Digestive System Surgical Procedures / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans