Single-Incision Laparoscopic-Assisted Anorectoplasty for the Management of Persistent Cloaca

Purpose: This study aimed to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with persistent cloaca. Materials and Methods: Five patients with persistent cloaca underwent SILAARP and repair of the urogenital sinus between June 2014 and February 2015. The mean age of the patients at the time of operation was 0.80 ± 0.16 year (range, 0.6-1.0 year). An extralong 5-mm 30° laparoscope was inserted through the 5-mm middle port. Two 3-mm lateral ports were placed for instruments. The three ports were placed at a horizontal line through a 2-cm transumbilical incision. CO₂ pressure was maintained between 8 and 12 mm Hg. The patients were evaluated for fecal continence and complications. Results: SILAARP and repair of the urogenital sinus were successfully performed in all patients. The mean operation time ranged from 120 minutes to 130 minutes. The operative blood loss was minimal. There were no operative complications. All patients were followed up for 0.64 ± 0.29 year (range, 0.3-1.0 year). No patient developed fecal incontinence. Two of the 5 patients (40%) had two to four stools per days, but this did not cause social problems. Only 1 patient (20%) had constipation and required changes in diet. No wound infection, port-site hernia, urethrovaginal fistula, acquired anorectal atresia, or urethral injury occurred. Conclusions: Our results show that SILAARP is an effective and safe option for patients with persistent cloaca.