G. Chiari et al., Bilateral anterior pubic osteotomy in bladder exstrophy repair: report of increasing success, PEDIAT SURG, 17(2-3), 2001, pp. 160-163
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.