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Steel minus Salter (SMS) osteotomy in recurrent bladder exstrophy repair: a case report
Alshahid A Abbak1, Khalid I Khoshhal
1Consultant Pediatric Orthopedic Surgeon, King Fahad Medical City, Riyadh, Saudi Arabia,
Insights
Bladder exstrophy reconstruction can fail, leading to dehiscence. This case highlights successful pelvic osteotomy and soft tissue release for recurrent bladder exstrophy repair in a child.
Area of Science:
- Pediatric surgery
- Congenital anomalies
- Urology
Background:
- Bladder exstrophy is a rare congenital condition requiring early surgical repair.
- Postoperative dehiscence of the bladder and abdominal wall is a significant complication.
- Recurrence of pelvic diastasis can complicate initial reconstructions.
Observation:
- An 11-year-old girl with bladder exstrophy experienced recurrent pelvic diastasis and abdominal wall dehiscence after multiple prior surgeries.
- Previous iliac bone supra-acetabular osteotomies failed to maintain pelvic closure.
- The patient presented with a widely open symphysis and bladder/abdominal wall separation.
Findings:
- Bilateral pubic and ischial rami osteotomies were performed.
- Adequate soft tissue release was achieved in conjunction with the osteotomies.
- This allowed for a tension-free repair of the bladder and anterior abdominal wall.
Implications:
- This surgical approach (pelvic osteotomy with soft tissue release) offers a viable solution for complex, recurrent bladder exstrophy cases.
- Successful long-term closure was achieved, as evidenced by over three years of follow-up.
- This technique may improve outcomes for patients with challenging bladder exstrophy recurrences.
Abstract:
Bladder exstrophy is a very rare congenital disorder, in which the first stage of reconstruction is usually performed within the first 72 hours of life. The most feared form of failure of the reconstruction is postoperative dehiscence of the bladder and abdominal wall. We present an 11-year-old girl with bladder exstrophy. She underwent three iliac bone supra-acetabular osteotomies with repair of the bladder exstrophy. Unfortunately the diastasis of the symphysis recurred widely open with dehiscence of bladder and abdominal wall. Bilateral pubic and ischial rami osteotomies with adequate soft tissue release were carried out, which allowed the urology team to perform a tension-free repair of the bladder and the abdominal wall. Here we report an osteotomy with the soft tissue release that succesfully allowed the closure of the pelvis, bladder and anterior abdominal wall in a recurrent case with more than three years follow up.
