title: A new approach for persistent cloaca: Laparoscopically assisted anorectoplasty and modified repair of urogenital sinus.
abstract: OBJECTIVE
  The aim of this study is to describe the surgical technique and evaluate midterm outcomes of the technique: laparoscopically assisted anorectoplasty (LAARP) and modified repair of urogenital sinus.
  
  
  METHODS
  Seven patients with persistent cloaca underwent LAARP and modified repair of urogenital sinus between November 2005 and December 2010. The ages of the patients at the time of operation were 6 months to 15 years. Distal colostogram and micturating cystogram were performed preoperatively to identify the type of persistent cloaca. The rectal pouch was above the pubococcygeal line in all patients. The operations were carried out using 3 trocars. CO2 pressure was maintained at 8-12 mm Hg.
  
  
  RESULTS
  Laparoscopically assisted anorectoplasty and modified repair of urogenital sinus were successfully performed in all cases. Mean operation time was 125.7±8.4 minutes (range, 110-135 minutes). Intraoperative blood loss was minimal. There were no intraoperative complications. Follow-up was obtained in all patients. The median follow-up period was 5.7±2.1years (range, 4-9 years). Mucosal prolapse occurred in 2 cases (28.6%). No urethrovaginal fistula, acquired anorectal atresia or urethral injury was observed. Only 1 patient (14.3%) was incontinent of urine occasionally but urine retention or vesicoureteral reflux was not observed. Two patients (28.5%) had 2-4 stools per day but no social problem. Only 1 patient (14.3%) had constipation and required laxatives.
  
  
  CONCLUSIONS
  Anoplasty, vaginoplasty and urethroplasty can be performed simultaneously in patients with persistent cloaca through LAARP and modified repair of urogenital sinus.
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China; Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China. Electronic address: lilong231@126.com.
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Surgery, United Family Hospital, Beijing, China; Department of Pediatrics and Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia. Electronic address: wei.cheng3@gmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Shuli
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Guoliang
authors.initials: G
authors.lastname: Qiao
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000071056:Anorectal Malformations; D001006:Anus, Imperforate; D002988:Cloaca / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D014624:Vaginal Fistula / Q000601:surgery*
keywords: Laparoscopicaly assisted anorectoplasty; Persistent cloaca; Total urogenital mobilization; Urethroplasty; Vaginoplasty