title: Early versus late reconstruction of cloacal malformations: the effects on postoperative complications and long-term colorectal outcome.
abstract: BACKGROUND
  Patients with a cloacal malformation generally undergo reconstructive surgery within the first years of life. However, the ideal age for surgery has rarely been mentioned. The aim of this study was to report differences in outcome between early (<6 months) and late repair of cloacal malformations.
  
  
  METHODS
  Charts of patients with a cloacal malformation treated in 5 pediatric surgical centers between 1985 and 2009 were retrospectively studied for associated anomalies, postoperative complications, and colorectal and urological outcome.
  
  
  RESULTS
  Forty-two patients were eligible for this study, giving a mean exposure of less than 1 patient yearly per center. Forty-five percent of the patients had a short common channel (>3 cm), and 14% had a long common channel. Length of common channel was missing in 41% of the patients. Median age of the cloacal reconstruction was 9 months (range 1-121 months). Twelve patients (29%) underwent an early surgical repair (within the first 6 months of age; median 3 months), and 30 (71%) patients underwent a late repair (after 6 months of age; median 14 months). Eighteen postoperative complications (<30 days) had been documented in 15 patients (35%), with significant more perineal wound dehiscences in patients with an early repair (42% vs. 10%, p=0.031). There were no differences in complication rate between patients with short and long common channels. Mean follow-up was 142 months (range 15-289). At the last follow-up, 10 patients (24%) had voluntary bowel movements. Fourteen patients (33%) had complaints of soiling, 25 (60%) were constipated, with no differences between the early and late repair groups. Patients in the late repair group as well as the group of patients with a short common channel were more frequently able to void spontaneously.
  
  
  CONCLUSIONS
  Postoperative complications are common in patients with cloacal malformations. Early repair is associated with more wound dehiscences, however, without affecting long-term functional outcome. All centers had limited annual exposure of less than 1 patient. In these clinical settings, ideal age of cloacal reconstruction seems to be between 6 and 12 months. In general, centralized care for these complex malformations may be the crucial factor for reducing postoperative complications and better long-term outcome.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: h.versteegh@erasmusmc.nl.
authors.forename: Hendt P
authors.initials: HP
authors.lastname: Versteegh
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Cornelius E J
authors.initials: CE
authors.lastname: Sloots
authors.affiliation: Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Justin R
authors.initials: JR
authors.lastname: de Jong
authors.affiliation: Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Christien
authors.initials: C
authors.lastname: Sleeboom
authors.affiliation: Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Roxana
authors.initials: R
authors.lastname: Rassouli
authors.affiliation: Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Rene M H
authors.initials: RM
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Ivo
authors.initials: I
authors.lastname: de Blaauw
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery
keywords: Associated anomalies; Cloacal malformations; Constipation; Fecal soiling