Bilateral anterior pubic osteotomy in bladder exstrophy repair: report of increasing success

Bilateral posterior iliac osteotomy is performed in most patients undergoin g primary closure of an exstrophic bladder; the aims are to facilitate abdo minal-wall closure, prevent postoperative wound dehiscene, and possibly, to achieve better urinary control in older age. A new technique, anterior pel vic osteotomy of the superior pubic ramus, seems to obtain tension-free sym physis approximation safely and quickly. We report our initial experience w ith this osteotomy. Five neonates, four males and one female from 1 to 4 da ys old, all underwent closure surgery for bladder exstrophy (BE) and subseq uent bilateral osteotomy of the superior pubic ramus (SPRO). Postoperativel y, Bryant's traction was applied. Tension-free, complete approximation of t he symphysis and uncomplicated healing were achieved in all five cases with out palsy of the obturator nerve or postoperative hemorrhage. Follow-up rev ealed partial rediastasis with a stable anterior pelvic ring. Tension-free closure and immobilization are important factors in both initial and subseq uent closure of BE. Several osteotomy techniques are currently in use. SPRO presents numerous advantages? namely, ease and rapidity, minimal blood los s, and no requirement for an extra skin incision or need to turn the patien t on the operating table. A certain degree of rediastasis with growth was s ubsequently observed: although undesirable, this complication is common to all osteotomy techniques. We believe that SPRO is a valid and uncomplicated method to facilitate BE closure.