Complications and Long-Term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina...

Dr. Megan Reed Ivaturi from Nationwide Children's Hospital discusses a recent study published in the Journal of Pediatric Surgery on the long-term outcomes of bowel neovagina creation for patients with cloacal malformations. The study evaluated 40 patients, comparing outcomes between small bowel and colonic neovaginas, and highlighted the importance of long-term follow-up for function, stenosis, and quality of life. Kristine L Griffin, Wendy Jo Svetanoff, Megan A Read, Shruthi Srinivas, Geri Hewitt, Richard J Wood, Chelsea A Kebodeaux Introduction: Up to 60 % of patients with a cloacal malformation have a Mullerian anomaly. In cases where the vagina is absent or cannot reach the perineum, an intestinal neovagina is often created. The complications and outcomes of this are not well described. We aimed to describe the gynecologic outcomes of patients who underwent neovagina creation followed at our institution. Methods: A single institution retrospective review of patients ≥8 years old with cloacal malformation who underwent intestinal neovagina creation was performed. Demographics, surgical history, short-term complications, and long-term gynecologic outcomes were assessed. Results: Forty patients were included. The median age at neovagina creation was 3.95 years (IQR 1.40, 7.61). Twelve patients (30 %) had uterine agenesis. Neovagina was colonic in 27 (67.5 %) and small bowel in 12 (30 %). Median age at most recent follow up was 9.7 years (IQR 7.6, 14.1). There was no difference in 30-day complications, incidence of vaginal prolapse, introital stenosis, or graft stenosis between those undergoing small bowel vs colonic neovagina. Two patients had documented menstrual obstruction, and 11 patients reported bothersome vaginal discharge. Of those with neovagina prolapse, one small bowel (8.3 %) and two colonic grafts (7.4 %) required prolapse repair. One small bowel (8.3 %) and 7 colonic (26 %) patients underwent introitoplasty for stenosis. Of the 3 patients having penetrative sex, 2 reported dyspareunia. No patients have become pregnant. Conclusion: Bowel neovaginas remain a suitable choice for patients with cloacal malformations in whom the vagina is absent or cannot reach the perineum. For more information, visit the Center for Colorectal and Pelvic Reconstruction (CCPR): https://www.nationwidechildrens.org/specialties/colorectal-and-pelvic-reconstruction-ccpr