Anterior Pelvic Osteotomy. A New Operative Technique Facilitating Primary Bladder Exstrophy Closure

Abstract

Posterior iliac osteotomy is a recognised method employed to facilitate and support anterior abdominal wall closure in patients with bladder exstrophy, but it adds considerably to the already lengthy procedure of bladder exstrophy surgery. Anterior pelvic osteotomy of the superior ramus of the pubic bone was developed to overcome this problem and to achieve a stable anterior pelvic ring with tension-free soft tissue closure. It can easily be performed after completing the bladder closure, without the need to turn the patient.

Steel minus Salter ( SMS ) Osteotomy in Recurrent Bladder Exstrophy Repair : A Case Report

“…(13) But in what was discribed the approximation of symphysis pubis was achieved in infants at the cartilaginous ischiopubic junction, while in older children fracture of the inferior rami of the pubic bone allowed the approximation but the ischial ramus was not osteotomized. (14) A repeat closure of the pelvis may offer some extra benefits with respect to correcting the pelvic rotational deformity.…”

Anterior Pelvic Osteotomy of Superior Pubic Rami as Adjunctive Measure to Repair the Primary and Recurrent Cases with Bladder Extrophy

“…Anterior pelvic osteotomy was first described by Frey and Cohen in1985 [9] , for repair of patients with bladder extrophy. This type of osteotomy has many advantages; the operative duration is reasonable, with no need to change the patient's position, minimal blood loss, can be used for both primary and re-do cases, regardless of patient age and no need for an orthopedic surgeon [14], [15] .…”

“…Different types and techniques of pelvic osteotomies have been described by many authors, which can be chosen according to the surgeon's preference and experience [7], [9]- [14] . Bilateral posterior iliac osteotomy described by Schultz in 1958 [7] .…”

“…With the initial bladder closure, attention was directed to the pelvic osteotomy, in which both crura were dissected from their attachment to inferior pubic wing. The technique of anterior pelvic osteotomy was the same as described by Frey and Cohen [9] .…”

“…Another osteotomy technique, first described by Frey and Cohen in 1988 and consisting of anterior pelvic osteotomy of the superior pubic ramus, seems to be a safe and quick alternative method to obtain tension-free approximation of the symphysis pubis [5], [9] . In this study we evaluate the feasibility of the bilateral anterior pubic osteotomy as adjunctive measure to simple closure of the bladder exstrophy and achieving a tension-free approximation of the symphysis pubis and abdominal wall.…”