Bilateral Anterior Pubic Osteotomy in Bladder Exstrophy Closure

Abstract

Anterior pelvic osteotomy of the superior ramus of the pubic bone is a simple and effi-cient method to facilitate symphyseal approximation and abdominal wall closure without or with low tension on the suture lines in neonates operated for bladder exstrophy. Older chil-dren for whom operation has been delayed can also benefit from this method. Compared with all other osteotomies in exstrophy surgery it does not require additional incisions nor does the patient need to be repositioned on the operating table. Successful operation does not depend on any particular orthopedic skills and can easily be done by the pediatric urolo-gist. We report our clinical experience with this alternative technique which we have per-formed in 16 patients who have been operated for bladder exstrophy. In particular the technique and its difficulties are discussed. The immediate postoperative results regarding abdominal wall closure were excellent in all 16 patients. Major postoperative complications however, were seen in two patients. Despite antibiotic prophylaxis, one child developed a severe soft tissue infection resulting in complete bladder dehiscence. In a further patient, an obturator nerve injury, resulting in transient palsy which recovered completely, was seen. The first complication was not related to the osteotomy; the second however, definitely was.