Surgical Treatment for Short Common Channel Cloaca – Posterior View | Cincinnati Children's скачать в хорошем качестве

Surgical Treatment for Short Common Channel Cloaca – Posterior View | Cincinnati Children's

  cincinnatichildrens.org   medical animation: Surgical Treatment for Short Common Channel Cloaca – Posterior View | Cincinnati Children's Here, we are watching a repair of a cloacal malformation with a common channel less than 3 centimeters. The first part of the operation involves dissecting the rectum from the posterior wall of the urogenital sinus, as seen here. Traction stitches on the edge of the rectum are used to create a plane between the posterior wall of the vagina and the anterior wall of the rectum, until the rectum is completely freed. At this point, the total urogenital mobilization is completed. Multiple fine sutures are placed around the edge of the vagina and urethra up to about 5 millimeters from the clitoris. At this point, the dissection begins anteriorly, and progresses laterally, with the goal of elevating what used to be the common channel, also referred to as the urogenital sinus, off of the pubis. As seen here, with sequential dissection, this structure can be completely freed from the pubis and from its lateral attachments. At this point, the suspensory ligaments are exposed, in avascular plane that can also be dissected, and division of these suspensory ligaments often allows these structures to be moved towards the perineum between 2 and 3 centimeters. At this point, the previous common channel is divided in the midline. The new position of the urethra is established at the mucosal edge, that was about 5 millimeters from the clitoris. Multiple [??] sutures are used to perform this anastomosis. The previous common channel has now become labia minora. And here, you see the introitoplasty portion of the cloaca repair, where multiple interrupted sutures are placed as traction is released, to create the vaginal introitus. At this point, the introitoplasty is complete, and the perineal body is closed up to the interior limits of the sphincters. This is performed with multiple layers with long-term absorbable suture. Once the perineal body is closed, the rectum is positioned in the center of the sphincter, and the posterior aspect of the incision is closed in layers, and the rectum is tacked. Again, it is important to close this wound in layers to prevent the creation of a large dead space. The skin is typically closed with long-term simple absorbable sutures. The anoplasty is now performed. The rectum is first divided in the midline, down to the level of the skin. Sutures are placed in a u-type fashion from the skin through the bowel and back out of the skin at the 12 and 6 o’clock positions to anchor the rectum The excess rectal tissue is then excised. And the remainder of the anoplasty is completed with multiple long-term absorbable sutures, even spaced circumferentially around the rectum. As the sutures are cut, the anus retracts into its position in the gluteal cleft, completing the operation.