Document Detail


Application of a continent fecal reservoir in patients with cloacal exstrophy.
MedLine Citation:
PMID:  19914652     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Initial enteric diversion in cloacal exstrophy is achieved by ileostomy or end colostomy with formal reconstruction in the form of hindgut pull-through performed in select patients. Those who are not candidates for a pull-through procedure are often left with a permanent incontinent stoma. Additionally due to congenitally deficient intestinal length, some patients with cloacal exstrophy experience short bowel syndrome. We present our surgical technique and clinical experience in 2 patients who were successfully treated with a novel continent cutaneous fecal reservoir. MATERIALS AND METHODS: We devised a fecal reservoir in 2 patients with end ileostomies who were deemed poor candidates for pull-through of the hindgut segment. One of the patients exhibited short bowel syndrome before undergoing reconstruction. A continent cutaneous fecal reservoir was created from all available hindgut and a segment of ileum. A flap valve mechanism was used to create a continent catheterizable channel. RESULTS: Seven years postoperatively both patients are continent of stool and neither has experienced complications attributable to enteric diversion. The patient with short bowel syndrome demonstrated significant improvement in nutritional status as evidenced by rapid weight gain and improvement in serum albumin level. Both patients and their families are highly satisfied with the surgical outcome. CONCLUSIONS: Hindgut and ileum can be combined to create a novel continent fecal reservoir. As an alternative to diverting ileostomy or colostomy, continent diversion offers potential metabolic and social advantages. Select patients with cloacal exstrophy will benefit from this form of enteric reconstruction.
Authors:
Christopher C Roth; Bradley A Wilson; Yusuf Kibar; Dominic Frimberger; Bradley P Kropp
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  183     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  290-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. christopher-roth@ouhsc.edu
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MeSH Terms
Descriptor/Qualifier:
Child
Cloaca / abnormalities*,  surgery*
Colonic Pouches*
Digestive System Surgical Procedures / methods
Follow-Up Studies
Humans
Comments/Corrections
Comment In:
J Urol. 2010 Jan;183(1):15-6   [PMID:  19913805 ]
J Urol. 2010 Jan;183(1):296   [PMID:  19914643 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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