132 / 238
132
29
th
CONGRESS OF THE ESPU
CONCLUSIONS
The Kelly repair can be safely combined with delayed BE closure, without demonstrable risk of
bladder dehiscence.
14:27–14:30
S17-2 (PP)
TRANSPOSITION OF RECTUS ABDOMINIS MUSCLES
ALLOWING TENSION-FREE MIDLINE CLOSURE AFTER
BLADDER EXSTROPHY REPAIR. A PRELIMINARY STUDY
Sébastien FARAJ
1
, Solène JOSEPH
1
, Sajid SULTAN
2
, Yves HELOURY
3
, Philip
RANSLEY
2
and Marc-David LECLAIR
1
1) Hôpital Mère-Enfant, Chirurgie Infantile, Nantes, FRANCE - 2) Sindh Institute of Urology and Transplantation,
Pediatric Urology, Karachi, PAKISTAN - 3) Royal Children Hospital, Pediatric Urology, Melbourne, AUSTRALIA
PURPOSE
Tension-free abdominal and pelvic closure is a major factor for adequate healing after bladder ex-
strophy repair. It has been reported that pubic approximation may result in compartment syndrome
or a kink of pudendal pedicles after complete mobilisation, and therefore contributes to an increased
risk of corporal and glans ischemia. We investigated the efficacy of a midline transposition of the
rectus-abdominis muscles (TRAM) to ensure tension-free closure after radical soft-tissue mobilisa-
tion (RSTM, or Kelly repair) for exstrophy and proximal epispadias repair without osteotomy nor
pubic approximation.
PATIENTS & TECHNIQUE
Retrospective study of consecutive cases of bladder exstrophy/epispadias who underwent RSTM
with TRAM at 4 collaborating institutions from Apr. 2016 to Sept. 2017.
After full RSTM including cervico-urethroplasty, penile reconstruction, vesico-ureteric reimplanta-
tion, and bladder closure, the rectus abdominis were lifted from the iliopubic branches with a strip of
periosteum, and mobilised medially to allow midline closure. No pelvic osteotomies were performed.
Outcome criteria included abdominal wall breakdown, internal hernia, wound infection, and bladder
dehiscence.
RESULTS
During the 18-month study period, 23 cases of RSTM+TRAM were performed in 16 bladder exs-
trophy cases (10 combined delayed bladder closure+RSTM, and 6 redo bladder-closure+RSTM,
12M/4F), and 7 proximal epispadias (4M/3F). With a median follow up of 11 months [3–18], no
abdominal wall dehiscence was observed. Among the 16 bladder exstrophy cases, none presented
with bladder dehiscence. Internal incisional hernia was observed in 3 cases, through the space
between the inferior edge of the muscles and the pubic branch, of whom 1 required secondary
repair. Minor skin wound infection or dehiscence was treated conservatively in 6 cases.
CONCLUSIONS
Midline transposition of the rectus abdominis muscles allows tension-free closure of the abdominal
wall after exstrophy repair with limited morbidity.