Laparoscopic-Assisted Anorectal Pull-Through for Persistent Cloaca in Two Girls

Aim: The aim of this study was to present our technique and the surgical approach for assisted laparoscopic anorectal pullthrough and the initial out-come in two girls with persistent cloaca. Patients and methods: Laparoscopic assisted anorectal pull-through was done in 2 girls with persistent cloaca between 2008 and 2011 in two different French centers. Diverting colostomy was performed during the neonatal period. The common channel length was 2.5 and 4 cm respectively and their surgical repair was performed at 16 and 6 months of age respectively. The first girl had a delayed surgical repair for growth problem. The laparoscopic pull-through, the anoplasty and the mobilization of the urethra were done at the same time. Results: Laparoscopic assisted pull-through was successfully performed in the two girls. There was no intra-operative or postoperative complication. Length of stay was 15 and 12 days respectively. The colostomy was closed at 9 and 3 months of age. Anal dilatation was started 3 weeks after the surgery and continued for 4 months after closure of the colostomy. Follow-up was 30 months and 18 months, respectively. Conclusion: Simultaneous laparoscopic assisted pull-through and urethral mobilization for the management of persistent cloaca is a feasible, effective and safe surgical option. This technique provides an optimal view of the pelvic organs, better identification of fistula and minimizes abdominal scars. Large prospectively conducted studies with prolonged follow-up periods are required to further validate this approach.