Short term complications of persistent cloaca reconstruction - A single-institution review of 53 cloacal reconstructions.

PURPOSE: To describe short-term complications following cloaca repair and evaluate their relationship with cloaca complexity.

METHODS

A prospective institutional registry of patients evaluated for persistent cloaca from 2020 to 2025 was used to identify patients undergoing primary repair at our institution. Early complications (prior to scheduled examination under anesthesia at 6-12 weeks) were graded by Clavien-Madadi scale to determine complication rate, severity, setting and type.

RESULTS

Among 104 patients evaluated, 53 met inclusion criteria, undergoing cloacal reconstruction at median age of 0.7 years (IQR 0.6-1.5). 40% had complex cloaca (common channel ≥3 cm, 21/53) and 55% underwent urogenital separation (29/53). Median operative time was 307 min (ΙQR 206-414). Median length of stay was 4 days (IQR 2-7). Patients with complex cloaca had higher usage of urogenital separation (86%[18/21] v. 34%[11/32], p = 0.001) with longer operative time (445 v. 238 min, p < 0.001) and hospital stays (7 vs 2 days, p = 0.002). 39 complications occurred in 24 patients (45%). Patients with complex and moderate anatomy had similar complication rates (57% v. 38%, p = 0.16). Most complications were ≤Clavien-Madadi 3a (31/39, 79%) and occurred at similar rates in the intra-operative, inpatient and post-discharge settings. Most were related to surgery (34/39, 87%) with 38% of all complications (15/39) involving the genitourinary system (injury, infection or retention). Transfusion was the only complication associated with complex anatomy (33% v. 0%, p = 0.001).

CONCLUSION

Early complications occurred in nearly half of patients following cloacal repair. Most events were minor and frequently involved the genitourinary system. These data can inform counseling, management and surgical techniques.

IRB APPROVAL: Pro00015991.