Outcomes From Colonic Pull-Through for Cloacal Exstrophy Differ by Colon Length: A Multi-Institutional Study


Shruthi Srinivas, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. Electronic address: shruthi.srinivas@nationwidechildrens.org.
Maria E. Knaus, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Jeffrey R. Avansino, Department of Surgery, Seattle Children's, University of Washington, Seattle, WA, USA.
Andrea Badillo, Department of Surgery, Children's National Hospital, George Washington University, Washington, DC, USA.
Casey M. Calkins, Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
Belinda H. Dickie, Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA.
Megan M. Durham, Department of Surgery, Emory + Children's Pediatric Institute, Atlanta, GA, USA.
Megan K. Fuller, Department of Surgery, Boys Town National Research Hospital, Boys Town, NE, USA.
Matthew W. Ralls, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Rebecca M. Rentea, Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.
Michael D. Rollins, Division of Pediatric Surgery, Primary Children's Hospital, University of Utah Health, Salt Lake City, UT, USA.
Kathleen van Leeuwen, Division of Pediatric Surgery, Phoenix Children's Hospital, Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
Richard J. Wood, Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. Electronic address: Richard.Wood@nationwidechildrens.org.

Document Type

Journal Article

Publication Date



Journal of pediatric surgery




Anorectal malformation; Continence; Ostomy; Surgical outcomes


BACKGROUND: Cloacal exstrophy (CE) represents a rare sub-group of anorectal malformations. Traditionally managed with a permanent colostomy, colonic pull-through (PT) has emerged to allow cleanliness without a life-long stoma. We sought to understand outcomes of PT in a large multi-center CE population. METHODS: We performed a retrospective study involving eleven pediatric hospitals. We gathered data on demographics, outcomes, and anatomical factors including colon length. Continuous variables were analyzed with Wilcoxon rank-sum tests and categorial variables with Fisher's exact tests. RESULTS: There were 98 patients, of which the majority (n = 70, 71.4 %) never underwent PT. There were no differences in exstrophy type, demographics, or associated anomalies. Median age at PT was 1.3 years (IQR 0.3-3.7). Of the cohort that continue to use their PT, the majority (n = 16, 69.6 %) are not clean. In total, 7.1 % (n = 7) of the cohort is clean with a PT, and only one patient is continent. Clean patients have a longer colon length than those who are not clean or opt for re-do ostomy (64.0 cm [IQR 46.0-82.0] vs 26.5 cm [IQR 11.6-41.2], p = 0.005). CONCLUSION: Overall, we demonstrate that most children born with CE will keep their stoma. Only a small percentage who elect to undergo colonic PT are clean for stool. Greater colon length correlates with success. This suggests that multiple factors, including colon length, are important when considering PT in a child with CE. LEVEL OF EVIDENCE: III.