Pubic osteotomy minimal for abdominal wall closure in exstrophy bladder

We describe a novel 'pubic osteotomy minimal' (POM) done on body of pubis just lateral to the insertions of rectus abdominis and adductor longus muscles to bring rectus abdominis in midline without tension for abdominal wall closure without tension. In one patient, during pubic ramotomy, we missed middle of ramus and did osteotomy on the body on pubis found afterwards. Following good outcome, we did POM in another 17 patients. Abdominal wall closure was possible without tension and found satisfactory in all 18 patients in follow up. None had bladder wall dehiscence.