Outcomes of Colonic Pull-Through for Patients With Cloacal Exstrophy: Is it Really Helping Kids?

Outcomes of Colonic Pull-Through for Patients With Cloacal Exstrophy: Is it Really Helping Kids? 1024 683 Mary Bates, PhD

Collaborative study reveals infrequent utilization of the procedure and identifies factors correlated with success.

Cloacal exstrophy is a rare grouping of congenital anorectal malformations. Although once nearly uniformly fatal, survival has increased significantly, and with it, the focus on long-term outcomes. In the last 15 years, a reconstructive surgery known as colonic pull-through has been suggested as a first-line surgical approach to restore continence in children with cloacal exstrophy.

Now, a team including researchers from Nationwide Children’s Hospital report the findings from a large, multi-institutional study of the use of pull-through and subsequent outcomes in children with cloacal exstrophy.

“We wanted to know, now that pull-through has become an option, is it actually helping kids?” says Richard Wood, MD, chief for the Department of Pediatric Colorectal & Pelvic Reconstructive Surgery at Nationwide Children’s and the study’s senior author. “How is this big operation affecting continence?”

Dr. Wood and colleagues conducted a retrospective study of eleven pediatric hospitals participating in the Pediatric Colorectal and Pelvic Learning Consortium, a multi-institution collaborative.

“Since this disease is so rare, one institution on its own does not have enough patients to be able to draw meaningful conclusions,” says lead author Shruthi Srinivas, MD, a general surgery resident at The Ohio State University Wexner Medical Center. “By working with multiple institutions, we have access to not only a variety of patient types, but a variety of surgeons and care structures, as well, and that makes our data more generalizable.”

The researchers’ final dataset consisted of 98 patients, of which most (about 70%) did not undergo colonic pull-through.

“We found that this surgery is infrequently used in children with cloacal exstrophy, despite the fact that many trainees are taught that this is the operative approach that should be offered to families,” says Dr. Srinivas.

The team found that when colonic pull-through was performed, most patients did not achieve continence, although children with longer preoperative colon lengths had a higher likelihood of postoperative continence.

They conclude that colonic pull-through shouldn’t be the default procedure for children with cloacal exstrophy, but rather an option for select patients.

“Choosing the right patients for the right procedures can be a challenge in rare diseases,” says Dr. Wood, who is also a professor of surgery at The Ohio State University. He says that future prospective studies that leverage large datasets are needed to identify which patients will benefit the most from colonic pull-through.

“In the end, we hope that improving patient selection will help us improve outcomes for these patients,” says Dr. Wood.



Srinivas S, Knaus ME, Avansino JR, Badillo A, Calkins CM, Dickie BH, Durham MM, Fuller MK, Ralls MW, Reeder RW, Rentea RM, Rollins MD, van Leeuwen K, Wood RJ; Pediatric Colorectal and Pelvic Learning Consortium. Outcomes from colonic pull-through for cloacal exstrophy differ by colon length: A multi-institutional study. J Pediatr Surg. 2024 Feb;59(2):225-229. doi: 10.1016/j.jpedsurg.2023.10.019. Epub 2023 Oct 21.

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About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.