Single-Stage Surgery for Persistent Cloaca With Vertebral Defects, Anal Atresia, Cardiac Defects, Tracheoesophageal Fistula or Atresia, Renal Anomalies, and Limb Defects (VACTERL) Association: A Case Report on Avoiding Temporary Colostomy

The standard treatment for persistent cloaca (PC) in patients with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula or atresia, renal anomalies, and limb defects (VACTERL) association typically involves an initial colostomy to decompress the intestine and prevent urinary tract infections. However, patients with VACTERL association often require multiple surgeries, including gastrostomy for esophageal atresia, open-heart surgery, and spinal surgery requiring a prone position, which can complicate subsequent procedures. Here, we describe two cases of PC with VACTERL association successfully managed without a temporary colostomy until definitive surgery. Instead of a colostomy, a continuous transanal drainage system was used for bowel decompression. Both patients underwent single-stage laparoscopic anorectoplasty and perineal urogenital mobilization without major complications such as enterocolitis or urinary tract infections. The conventional approach to PC typically requires three laparotomies: colostomy, definitive repair, and colostomy closure. Our experience suggests that, in selected cases, a single-stage surgical approach without a temporary colostomy may offer a feasible alternative in appropriately selected cases.