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A Case Series of Successful Abdominal Closure Utilizing a Novel Technique Combining a Mechanical Closure System with a Biologic Xenograft that Accelerates Wound Healing
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Complex abdominal wall reconstruction combined with bladder closure in OEIS complex.

Rachel Davis1, Dylan Stewart2, Mahir Maruf1

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Summary

Bioprosthetic material aids abdominal closure in cloacal exstrophy (CE) patients. Older age at closure was linked to its use, but it did not significantly affect complication rates.

Keywords:
Abdominal wall defectsBioprosthetic materialBladder closureCloacal exstrophyReconstruction

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Area of Science:

  • Pediatric Surgery
  • Congenital Abnormalities
  • Reconstructive Surgery

Background:

  • Cloacal exstrophy (CE) presents significant abdominal defects and pubic diastasis, often necessitating complex surgical closure.
  • Bioprosthetic materials offer a potential solution to bridge large gaps during abdominal wall reconstruction in CE.

Purpose of the Study:

  • To investigate presurgical factors associated with bioprosthetic material use in CE abdominal closure.
  • To evaluate complications in CE patients undergoing abdominal closure with or without bioprosthetic materials.

Main Methods:

  • Retrospective review of a 20-year institutional database (1998-2018) of patients with CE.
  • Inclusion criteria: CE diagnosis, primary closure at the institution, and at least 3 months follow-up.
  • Data collected: demographics, presurgical factors, bioprosthetic material use, complications, and outcomes.

Main Results:

  • Thirty-two CE patients underwent staged closure and pelvic osteotomy; 10 utilized bioprosthetic material.
  • Successful bladder closure without postoperative hernias was achieved in all patients.
  • Patients not receiving bioprosthetic material were younger at closure (p=0.043); complication rates and pubic diastasis were not significantly different.

Conclusions:

  • Older age at abdominal wall and bladder closure is associated with the use of bioprosthetic material in CE reconstruction.
  • Bioprosthetic material serves as a valuable adjunct for secure abdominal wall closure in complex CE cases.