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Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications

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The failed bladder closure in cloacal exstrophy: Management and outcomes.

Rachel Davis¹, Amol Sood¹, Mahir Maruf¹

¹Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.

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|March 19, 2019

Summary

Successful secondary bladder closure in cloacal exstrophy (CE) is linked to pelvic osteotomy and external fixation. Achieving primary closure is ideal, but these techniques improve reclosure success in complex cases.

Keywords:

Bladder exstrophy Cloacal exstrophy Osteotomy Pediatric urology

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Area of Science:

Pediatric Surgery
Urology
Congenital Anomalies

Background:

Cloacal exstrophy (CE) is a severe form of the Exstrophy-Epispadias Complex (EEC).
CE presents with an omphalocele, complicating primary bladder and abdominal wall closure.
Failed primary bladder closure necessitates secondary closure, posing significant surgical challenges.

Purpose of the Study:

To identify patient and surgical factors predicting successful secondary bladder closure in CE patients.
To analyze outcomes of secondary bladder closure following failed primary attempts.

Main Methods:

Retrospective review of a single institution's Exstrophy-Epispadias Complex database (1975-2015).
Inclusion criteria: CE patients with failed primary bladder closure requiring secondary closure.
Analysis of patient demographics, surgical techniques, and closure outcomes.

Main Results:

Twenty-four CE patients met inclusion criteria.
Secondary closure success rates varied significantly by institution (100% vs. 12.5%).
Older age at secondary closure, pelvic osteotomy, and Buck's immobilization with external fixation were associated with successful outcomes.

Conclusions:

Pelvic osteotomy and Buck's immobilization with external fixation are key factors for successful secondary bladder closure in CE.
While reclosure is possible, it often requires multiple procedures.
Maximizing efforts for successful primary bladder closure remains paramount in managing CE.