A Modification of the Newborn Operation for Cloacal Exstrophy: Leaving the Cecal Plate Untouched.

Autor:	Bokova E; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States., Jacobs SE; Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States., Tiusaba L; Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States., Ho CP; Department of Urology, Children's National Hospital, Washington, District of Columbia, United States., Varda BK; Department of Urology, Children's National Hospital, Washington, District of Columbia, United States., Pohl HG; Department of Urology, Children's National Hospital, Washington, District of Columbia, United States., Feng C; Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States., Lane VA; Department of Paediatric Surgery, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom., Smith CA; Department of Pediatric and Thoracic General Surgery, Seattle Children's Hospital, Seattle, Washington, United States., Badillo AT; Department of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States., Wood RJ; Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States., Levitt MA; Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States.
Jazyk:	angličtina
Zdroj:	European journal of pediatric surgery reports [European J Pediatr Surg Rep] 2024 Oct 21; Vol. 12 (1), pp. e63-e67. Date of Electronic Publication: 2024 Oct 21 (Print Publication: 2024).
DOI:	10.1055/s-0044-1791814
Abstrakt:	The conventional approach to managing a newborn with cloacal exstrophy typically includes separating the cecal plate from between the two hemibladders, tubularizing it to be included in the fecal stream, creating an end colostomy, and bringing the two bladder halves together. This study introduces an alternative approach wherein the cecal plate is retained in its original position and designated for future use as an autoaugment of the bladder. Four cases of cloacal exstrophy cases managed between November 2019 and February 2024 are described, with surgical approach and postoperative outcomes reported. Two patients who underwent traditional reconstruction experienced bacterial overgrowth attributed to stasis in the cecal plate, which manifested in increased ostomy output and feeding intolerance. Treatment in these two cases was to remove the cecum from the fecal stream and use it instead for a bladder augment. Learning from these cases, the third and fourth newborn's approach involved retaining the cecum in situ for autoaugmentation of the bladder and performing an ileal to hindgut anastomosis. No postoperative acidosis occurred in these patients. The alternative approach to the newborn management of cloacal exstrophy whereby the cecal plate is left in situ can decrease stasis and postoperative bacterial overgrowth. It allows for an autoaugmentation of the bladder and is technically easier than the traditional rescue of the cecal plate from within the two hemibladders. Competing Interests: Conflict of Interest None declared. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)
Databáze:	MEDLINE
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