Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy.

In the management of cloacal exstrophy, controversy exists regarding use of the rudimentary hindgut as a terminal colostomy v salvage of the hindgut for urinary or genital tract reconstruction. Over the past 26 years, 19 patients with cloacal exstrophy have undergone surgical reconstruction at our institution. Ten were managed by terminal ileostomy with an average follow-up of 9 years; nine were managed by permanent colostomy with an average follow-up of 8 years. The number of in-hospital days required due to gastrointestinal (GI) complications and the number of days required for supplemental parenteral hyperalimentation were significantly higher in patients managed by terminal ileostomy than by colostomy (P less than .05 and P less than .03, respectively). All patients have had continued long-term follow-up evaluations in regard to their weight and growth velocities. There is essentially no difference in regard to these characteristics within the two patient population groups. In summary, patients with terminal ileostomies require more frequent hospitalization and prolonged intravenous nutrition during their initial management phase. However, as the child matures and adaptation of the intestine develops, it appears that there are no substantial differences between the growth characteristics of the two patient populations.