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

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.