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[Plastic repair of the anterior abdominal wall in bladder exstrophy]
Insights
This study presents a surgical technique for bladder exstrophy in children, improving abdominal wall repair and reducing complications. The modified approach significantly enhances healing and cosmetic outcomes for patients.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Context:
- Bladder exstrophy presents significant surgical challenges, particularly in managing the anterior abdominal wall defect post-bladder extirpation.
- Previous techniques reported a 16% complication rate, highlighting the need for improved reconstructive methods.
Purpose:
- To evaluate a modified surgical technique for bladder exstrophy in pediatric patients.
- To assess the efficacy of a novel approach to abdominal wall defect closure and its impact on postoperative complications.
Summary:
- A one-stage surgical treatment was performed on 35 children (8 months–3 years) with bladder exstrophy.
- The technique involved ureter transplantation, bladder extirpation, and abdominal wall repair using demucosed bladder tissue reinforced with sutures and covered with skin flaps.
- This method reduced postoperative complications by threefold, with minimal scarring and good cosmetic results.
Impact:
- The described surgical technique significantly decreases postoperative complications in bladder exstrophy repair.
- It offers a reliable method for abdominal wall defect closure, leading to improved patient outcomes and cosmetic results.
- This approach minimizes the risk of complications such as intestinal eventration and wound suppuration.
Abstract:
In 1987-1993 surgical treatment for exstrophy of the bladder was performed in 35 children at the age 8 months--3 years. All the patients underwent one-stage transplantation of the ureters into the semi-isolated segment of the sigmoid colon with antireflux protection of the ostia, bladder extirpation and repair of the anterior abdominal wall. The most difficult stage of the intervention is repair of the abdominal wall defect after removal of the large bladder. Related complications arising in 16% of the surgical patients impose the problem of the technique of safe filling of the abdominal wall defect. In 16 patients with large bladder its demucosation was followed by strengthening of the detrusor muscles with the help of interrupted sutures with fixation to underdeveloped oblique abdominal muscles. The skin defects was filled by raised movable skin flaps on both sides of the divided pubis. The above technique reduced the number of postoperative complications three times. Intestinal eventration was not observed. The wound suppuration and partial defect of the sutures occurred in 1 case. The rest 15 children exhibited healing with minimal scarring and good cosmetic effect.