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19–22 APRIL, 2017, BARCELONA, SPAIN
11:23–11:26
S7-9 (PP)
ANTERIOR PELVIC OSTEOTOMIES AND EXTERNAL
PELVIC FIXATION WITHOUT LOWER LIMBS TRACTION
IS A SUCCESSFUL STRATEGY TO AID DELAYED BLADDER
EXSTROPHY CLOSURE
David KEENE
1
, Cezar NICOARA
1
, Vytkis KAZLAUSKAS
1
, Alessandra SCALAS
1
,
Farhan ALI
2
, Sattar ALSHRYDA
2
and Raimondo CERVELLIONE
1
1) Royal Manchester Children’s Hospital, Department of Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal
Manchester Children’s Hospital, Department of Paediatric Trauma and Orthopaedic Surgery, Manchester, UNITED
KINGDOM
PURPOSE
Delayed bladder exstrophy closure (BEC) can benefit from a pelvic osteotomy to facilitate anterior
abdominal wall closure. The authors report the outcomes using a standardised strategy of routine
delayed, staged BEC in combination with bilateral osteotomies and external pelvic fixation, without
the need for lower limb traction.
MATERIAL AND METHODS
Since 2007, the authors have routinely delayed BEC to 3-6 months of age regardless of the size
and quality of the bladder template. Bladder pseudo-polyps, if present, are removed prior to closure
and a CT pelvis undertaken prior to closure. BE closure is performed with bilateral anterior oblique
osteotomies (single) with or without an additional posterior unicortical osteotomy parallel to the
sacro-iliac joint (combined double). An external fixator is placed for 3-4 weeks with a mermaid band-
age applied to the legs without traction for 5-6 weeks. Gender, age at closure and post-operative
complications were prospectively collected on consecutive patients undergoing exstrophy closure
between 2007 and 2016.
RESULTS
Sixty three patients (44 male) were treated during the study period and followed up for a median
duration of 3.7 years (IQR 2.6-6.3 years). Median age at time of bladder closure was 4 months (IQR
3-6 months). Median pubic diastasis was 4.5cm (4.0-5.1). Forty-nine patients had anterior oblique
osteotomies, 14 patients had a combined double osteotomy. All patients had a successful bladder
closure. No patients developed wound dehiscence, suprapubic fistula or bladder prolapse. None of
the patients developed lower limbs neuropathies or other orthopaedic complications.
CONCLUSIONS
Anterior oblique osteotomies and external fixation, without the need for lower limb traction, provides
a solid anterior abdominal wall closure which represents a key element for a successful and delayed
BEC.