Tailoring surgical approaches in different cloacal cases

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Aim of the study: This study describes surgical approaches for different cases of cloaca tailored to anatomical diversity and severity. Methods: A retrospective cohort study was conducted at Cairo University Specialized Pediatric Hospitals (2021-2024). Data included imaging findings [ultrasound, magnetic resonance image (MRI), distal loop gram, cloacogram, cystoscopy] and surgical techniques (single-stage or staged). Cases were categorized by vaginal depth and common channel length. Results: Among 20 patients, management was tailored to anatomy. For vaginal depth >2 cm: 4 cases with long common channels (>3 cm) had one-stage laparoscopic rectal and vaginal pull-through; 6 cases with short channels (<3 cm) underwent posterior sagittal rectal pull-through 2 partial urogenital mobilization (PUM),4 total urogenital mobilization (TUM). For staged procedures: 3 cases with long channels and rectal endings below the coccyx underwent rectal pull-through followed by vaginal pull-through; 5 short-channel cases had laparoscopic rectal pull-through followed by TUM (2) or PUM (3). Vaginal depth <2 cm required colon replacement in 2 cases. Conclusion: Surgical management of cloacal malformations requires individualized approaches based on anatomical factors.

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