Postoperative complications after reconstructive surgery for cloacal malformations: a systematic review

Abstract

The repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative complication seen after cloacal repair as reported in the literature. A systematic literature search was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Eight records were eligible for this study which were qualitatively analyzed according to the Rangel score. Overall complication rates reported in included studies ranged from 0 to 57 %. After meta-analysis of data, postoperative complications were seen in 99 of 327 patients (30 %). The most common reported complications were recurrent or persistent fistula (n = 29, 10 %) and rectal prolapse (n = 27, 10 %). In the PSARVUP group, the complication rate was 40 % and in the TUM group 30 % (p = 0.205). This systematic review shows that postoperative complications after cloacal repair are seen in 30 % of the patients. The complication rates after PSARVUP and TUM were not significantly different. Standardization in reporting of surgical complications would inform further development of surgical approaches. Other techniques aiming to lower postoperative complication rates may also deserve consideration.

Achieving Full Anatomical Correction in Girls with cloacal anomalies: A Necessity or an Overdoing?

“…The goals of surgical management in cases of cloaca are to preserve renal function as a priority, and to preserve the continence potential, as well as sexual and reproductive function in these patients [9] . Unfortunately, these goals have not been always achievable even in patients managed in highly specialized centers all over the world [1,5,16] . Sometimes, the unfavorable outcome may be related to innate 'uncorrectable' factors: renal dysplasia, Mullerian hypogenesis, and neurogenic factors (caudal regression).…”

“…Similarly, we thought that the persistent worldwide reporting on the unsatisfactory outcome in cases of cloaca [17] may be a stimulus to change our surgical concept in the management of these cases [18] . Achieving full anatomical correction in girls with cloaca (separate urethral and vaginal perineal orifices) is sometimes impossible without compromising the blood supply of these delicate organs and their potential for normal urinary continence [16,19,20] .…”

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

“…[4][5][6][7][8][9] Rates of wound dehiscence in PSARVUPs are likely underreported but range from 14 to 19%. [10][11][12] The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), an international group of specialists in the management of ARM, Hirschsprung disease, and other pediatric colorectal/pelvic conditions defines wound dehiscence as a wound disruption requiring some type of surgical intervention within 30 days of the initial operation. 13 For example, if a patient required only antibiotic therapy, local wound care, or an exam under anesthesia without any surgical intervention, they were not considered to have had a wound dehiscence.…”

Penile inversion vaginoplasty outcomes: Complications and satisfaction

“…Although complications can occur, many are selflimited and are commensurate with complication rates of complex genitourinary reconstruction performed for other diagnoses (ie, oncological and congenital). [7][8][9][10][11][12][13] This article will provide a thorough analysis of post-operative outcomes following penile inversion vaginoplasty, including topics related to patient satisfaction and adverse events.…”

“…Viruses, including Zika virus, Ebola virus, cytomegalovirus and human immunodeficiency virus (HIV), have been isolated from semen and can be sexually transmitted. 6,11,12 Furthermore, some viruses (eg HIV, Zika virus, herpes simplex virus (HSV) and human papillomavirus) can adhere to or be internalized by spermatozoa, 7,13 which may pose a risk for embryonic infection and cause adverse reproductive outcomes.…”