Repair of cloacal anomalies: current techniques.

This paper describes an experience with 29 additional cases of urogenital sinus malformation with an anorectal anomaly, usually rectal atresia with rectovaginal fistula. Right transverse divided colostomy is recommended in the neonate. Low end colostomy is contraindicated. After colostomy has been performed to relieve the intestinal obstruction, the urinary tract is the most life-threatening aspect of cloacal malformation. Intermittent catheterization of the bladder and/or urine-filled vagina can often provide adequate decompression; however, simple cystostomy or tube vaginostomy may be required in some. Major urinary diversion should be avoided. Occasionally, the urinary tract should be repaired before correcting other aspects of the malformation. In most cases rectal pull-through should not be performed first as an isolated procedure. In the majority of cases, all three systems can be repaired simultaneously, ie, rectum, vagina, and urinary tract. However, that is usually a large undertaking. The posterior sagittal midline approach, often together with an abdominoperineal approach, has proven very useful in these cases. An overall experience with 64 cloaca patients has shown that most can be repaired with a satisfactory functional and anatomic result.