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Cloacal Exstrophy: A Modification of the Newborn Operation - Leaving the Cecal Plate Untouched
Chapter 1 of 5 · Fundamentals
Traditional approach
Anatomy of Cloacal Exstrophy and Traditional Surgical Approach
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Cloacal exstrophy is the most complex of all anatomic problems faced by the pediatric reconstructive surgeon.
In cloacal exstrophy, the distal ileum and appendix are often intussuscepted.
The traditional approach to the newborn operation is to separate the cecal plate from within the two hemibladders, tubularize it, and add it to the fecal stream.
The rationale for the traditional approach was to maximize the amount of colon the patient had and to avoid resorption of urine by bowel mucosa.
Over time it became clear that the tubularized cecum was problematic as it led to stasis and bacterial overgrowth.
Urinary absorption by bowel did not lead to the clinical concern of acidosis that had been expected.
The new approach to the newborn operation leaves the cecal plate untouched and performs an ileal-to-hindgut anastomosis.
The new approach avoids the technically challenging separation of the cecal plate from between the two hemibladders.
The new approach allows for an auto-augmentation of the bladder.
The ileum-to-hindgut connection is a 1-to-1 size differential.
The new approach avoids the tubularized cecum, which down the road leads to problems related to dysmotility.
In this case, the hindgut measured about 12 centimeters in length.
The hindgut ended blindly as a colonic atresia.
In this case, essentially only the right colon was present.
A Cheatle maneuver was performed on the hindgut to set up a better aligned ileum-to-hindgut anastomosis.