CORRECTION OF CLOACA: RESULTS OF TREATMENT OF 16 CHILDREN WHO UNDERWENT 83 OPERATIONS IN 17 CLINICS
Authors:   Morozov Children's City Clinical Hospital, the department of Health Care of Moscow, Morozov D.D. , Sharkov S.M. ,   Morozov Children's City Clinical Hospital, the department of Health Care of Moscow,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Tarasova D.S. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Pimenova E.S. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Okulov E.A. ,   National Medical Research Center for Children's Health of the Ministry of Health, Morozov D.A. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University),   Yu.E.Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
Published: February 2022

Objective. To conduct a retrospective analysis of surgical treatment and long-term outcomes of treatment of children with cloaca, admitted to clinics of Sechenov University in the period from 2015 to 2019 years. Methods. Surgical treatment and long-term results were analyzed in 16 patients with cloaca. The age of the children at the time addressing to the clinic varied from the first day of life to 17 years. Long-term results were analyzed in children aged 2.5 to 17 years. In the late postoperative period, patients’ complaints, local status, functional state of the sphincter apparatus, and urination were analyzed. Results. Patients with cloaca were admitted to clinics of Sechenov University from 10 regions of the Russian Federation. Three children were hospitalized in the first day of life, 13 patients were admitted at various stages of treatment. In 14 children, a stoma was formed on the first day of life, in two - later than a month. Correction of the defect by means of a posterior-sagittal perineal approach was performed in 13 patients, in 3 patients the abdominal-perineal approaches were applied. Reoperations were required in 10 patients (63%). In the long-term postoperative period, neoanus stenosis was detected in 4 (25%) patients, and neointroitus infestatio - in 3 (19%) patients. Constipation was registered in 7 children (43%), fecal incontinence in 2 (13%). 10 (62%) children had various urinary disorders. Conclusion. We found that 16 patients with cloaca were treated in 17 clinics at different stages of treatment. At the same time, the majority of patients in the late postoperative period had problems with defecation and urination and required repeated surgical interventions. The results of the analysis indicate that treatment prospects of such patients treatment lies in the organization of interregional centers, with the possibility of concentrating material, technical and human resources, forming the flow of patients and their competent routing. What this paper adds For the first time, a comparative analysis of the stages of surgical treatment of a significant cohort of patients with extremely rare anorectal malformations - various variants of cloaca (16 children who underwent 83 surgical interventions in 17 clinics of the Russian Federation), the results of final surgical corrections at Sechenov University has been performed. It has been found that the majority of patients required staged operations, having significant violations of defecation and urination, which confirmed the need to organize surgical treatment of children with cloaca exclusively in specialized centers.