ESPU Congress 2018 - Abstract Book

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.