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Pelvic osteotomy in cloacal exstrophy: A changing perspective.

Nora M Haney1, Chad B Crigger1, Tamir Sholklapper1

  • 1Department of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Johns Hopkin Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States.

Journal of Pediatric Surgery
|July 29, 2022
PubMed
Summary

Multi-stage procedures and combined osteotomies significantly improve primary cloacal exstrophy closure success rates. These approaches, along with specific fixation methods, are key to better patient outcomes.

Keywords:
Bony pelvisCloacal exstrophyFixatorOsteotomyTrends

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Area of Science:

  • Pediatric Surgery
  • Urology
  • Orthopedic Surgery

Background:

  • Management of primary cloacal exstrophy (CE) closure involves variable osteotomy and pelvic fixation techniques.
  • Trends in osteotomy, immobilization, and multi-staging procedures for CE closure have not been well-documented over time.

Purpose of the Study:

  • To evaluate trends in primary CE closure using osteotomy, immobilization, and multi-staging procedures.
  • To assess the impact of these techniques on closure outcomes.

Main Methods:

  • Retrospective review of 122 patients undergoing primary CE closure from 1960 to 2020.
  • Analysis of demographics, osteotomy type, fixation methods, and outcomes.
  • Subanalyses based on the location of primary closure.

Main Results:

  • Multi-stage procedures became more common and were associated with higher success rates (77.4%) compared to single-stage (45.7%).
  • The use of osteotomy increased over time, with combined osteotomies showing the highest success rates (90%).
  • Buck's traction (92.1%) and external fixation (86.0%) were associated with the best immobilization success rates.

Conclusions:

  • Osteotomy and fixation techniques in CE management have evolved significantly.
  • A staged approach with combined osteotomy, utilizing a multidisciplinary team, is associated with improved outcomes in CE closure.