In so-called cloacal malformation (anal atresia), children do not have a rectal orifice or anus, or this is malformed. This condition affects one in every 5,000 children. The congenital malformation can be corrected by a highly complex surgical operation. Researchers from MedUni Vienna have now developed the first 3D model of a congenital cloacal malformation, for the first time allowing the endoscopic technique of cystoscopy to be used very realistically for examination and, hence also, a real operation to be simulated.
The background: in a case of anal atresia, the anus has to be surgically reconstructed. The operation involves closing the external or internal fistula and reconstructing the anus in the centre of the sphincter muscle. Depending upon the malformation, an artificial outlet has to be created for the colon.
As part of the FFG (Austrian Research Promotion Agency) infrastructure project M3dRES (project leader: Francesco Moscato), Carlos A. Reck (Department of Surgery, Division of Pediatric Surgery), Ewald Unger (Center for Medical Physics and Biomedical Engineering) and Azadejh Hojreh have now reconstructed a 3D model from the computer tomography data of a real malformation and this can now be used to practice the difficult operation realistically – previously junior doctors could only learn to do the procedure via "learning by doing". This new model will be presented at a workshop held on 7 December as part of the 12th European Pediatric Colorectal and Pelvic Reconstruction Congress in Vienna, which takes place from 4 to 7 December.
"The advantage of this model is that it allows paediatric surgeons and urologists to practise using cystoscopy and identifying the internal structures. In future, models could be used not only to train surgeons in this rare condition but also to practise the operation for a specific patient prior to the initial procedure. This will have a very positive impact upon the outcome for patients," emphasises Carlos Reck. The more precise the operation, the better the prospects for patients – this should improve even more in future, due to training sessions on the 3D model and prevent patients from suffering permanent incontinence or infertility.
About cloacal malformation
A distinction is made between forms of anal atresia that involve additional malformation and those that do not. For example, a fistula can occur between the rectum and urethra in boys and between the rectum and vagina in girls. So far, the causes are unknown, but it is presumed that genetic factors are mainly responsible. As a rule, the malformation is usually identified by the midwife directly after birth or by the paediatrician during the initial examination. It is hardly ever detected by ultrasound scans during pregnancy.
12th European Pediatric Colorectal and Pelvic Reconstruction Congress in Vienna from 4 to 7 December 2019 in the Parkhotel Schönbrunn, chaired by Carlos Reck and Alexander Springer from MedUni Vienna (both Department of Surgery).
For more information: www.colorectal-vienna.com. More than 300 experts are accredited, making this the largest paediatric surgery congress in Vienna in the last 15 years.