Abstract
Purpose:
Repairing abdominal wall defects after cloacal exstrophy reconstruction always poses
a challenge. Our proposal for repair consists of bilateral posterior iliac osteotomy
and external iliac fixation with Schanz pins, together with abdominoplasty through
bilateral groin flaps of skin and muscular aponeuroses, in a single staged procedure.
Methods:
7 patients (5 male and 2 female; mean age 3.1 years) with cloacal exstrophy underwent
reconstructive surgery at our institution. Cloacal exstrophy reconstruction was performed
in 3 stages, whenever possible. In Stage 1, the intestinal tract is separated from
the hemi-bladders; the small colon is tubularized (colorrhaphy) with an opening on
the left flank. The hemi-bladders are joined and the pathology is converted into classic
bladder exstrophy, followed by primary repair (cystorraphy). At this stage, closure
of the abdominal wall is made by groin flap plasty, following bilateral posterior
iliac osteotomy with an external iliac fixator. Stage 2 consists of bladder augmentation
and the management of urinary continence. Stage 3 is genitoplasty. The aim of this
study was to demonstrate our results for the first stage.
Results:
After a mean follow-up of 7 years, closure of abdominal wall was found to be excellent
and successful in all 7 patients. Their abdominal walls are strong and solid, with
no retraction, fistula or eventration.
Conclusion:
The association, in a single stage, of a posterior osteotomy with an external iliac
bone fixator and bilateral groin flaps for the closure of soft tissue defects of the
abdominal wall in cloacal exstrophy appears to be a safe and cosmetically acceptable
alternative technique.
Key words
bladder exstrophy - cloaca - iliac osteotomy
