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. 2025 Nov:122:103117.
doi: 10.1016/j.epsc.2025.103117. Epub 2025 Oct 8.

Combined endoscopic and laparoscopic surgery for staged repair of complex cloacal anomalies: A case series

Erica M Weidler  1   2 , Matthew Ralls  3 , Gwen Grimsby  2   4 , Marcus Jarboe  3 , Casey Calkins  5 , Kathleen van Leeuwen  1   2
Affiliations

Combined endoscopic and laparoscopic surgery for staged repair of complex cloacal anomalies: A case series

Erica M Weidler et al. J Pediatr Surg Case Rep. 2025 Nov.

Abstract

Introduction: The combined endoscopic and laparoscopic surgery (CELS) technique can be used during reconstruction for infants with complex congenital anomalies. In persistent cloacal malformations, this approach permits delineation of challenging anatomy and facilitates safer surgical separation of structures while minimizing tissue trauma for future procedures.

Cases presentation: Three patients with persistent cloacal malformations and complex upper tract reproductive anatomy underwent the CELS technique during their series of reconstructive procedures. The average age at first stage reconstruction, that included anorectoplasty, was 14 months (range 9-22). The average follow-up length from the time of reconstruction was 6.5 years (range 4-9 years). All patients have since undergone colostomy takedown. Two patients have undergone delayed vaginal pull-through and/or introitoplasty, and one patient has not yet undergone vaginoplasty.

Conclusion: The CELS technique may help reduce complications from open surgery, allows time for structural development, and minimizes tissue dissection and trauma at an early age. Staged repair for complex cloaca can be safely considered and allow for delay of vaginal reconstruction with minimal adverse short-term outcomes and impact on subsequent procedures.

Keywords: Case series; Cloaca; Endoscopic; Laparoscopic; Staged approach.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kathleen van Leeuwen, MD reports financial support was provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development under award R01HD093450. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1).
Fig. 1).
Unobstructed right hemi-uterus and hemi-vagina with insertion into bladder. Arrow shows unobstructed right hemi-uterus.
Fig. 2).
Fig. 2).
Instrumentation of left hemi-vagina to facilitate dissection of rectal fistula. Arrow shows instrumentation of left hemi-vagina.
Fig. 3).
Fig. 3).
Laparoscopic takedown and ligation of rectal fistula. Arrow shows ligation of rectal fistula.
See this image and copyright information in PMC

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