Cloacal Exstrophy: A Modification of the Newborn Operation - Leaving the Cecal Plate Untouched
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Cloacal exstrophy is the most complex of all anatomic problems faced by the pediatric reconstructive surgeon
In cloacal exstrophy, the distal ileum and appendix are often intussuscepted
The traditional newborn operation separates the cecal plate from within the two hemibladders, tubularizes it, and adds it to the fecal stream
The rationale for tubularizing the cecum was to maximize the amount of colon the patient had and to avoid resorption of urine by bowel mucosa
The tubularized cecum led to stasis and bacterial overgrowth
Urinary absorption by bowel did not lead to the clinical concern of acidosis that had been expected
Leaving the cecal plate untouched avoids the technically challenging separation of the cecal plate from between the two hemibladders
Leaving the cecal plate untouched allows for an auto augmentation of the bladder
The ileum to hindgut connection is a 1 to 1 size differential
Leaving the cecal plate untouched avoids the tubularized cecum which leads to problems related to dysmotility
In this case the hindgut was about 12 centimeters, a good length
The hindgut ended blindly as a colonic atresia
In this case, essentially this is just the right colon
A Cheatle maneuver on the hindgut was needed to set up a better aligned ileum to hindgut anastomosis