THE OUTCOMES OF BILATERAL PELVIC OSTEOTOMIES FIXATION IN BLADDER EXSTROPHY WITH EXTERNAL FIXATOR

Objective: To present the initial results of pelvic osteotomies for the correction of bladder exstrophy. Study Design: A Case Series. Place and Duration: The study was conducted in the Surgical Unit I of the Bahawal Victoria Hospital, Bahawalpur for a duration of 3 years from January 2013 to January 2016. Methods: 5 cases with bilateral exstroflexia were presented, and were treated using closed bilateral iliac osteotomy. From amongst, 3 patients were operated on with the employment of pubic symphysis diastasis using one screw and additional cerclage wires, and one patient using Kirschner wires. The external fixators were then duly sutured. During the follow-up period, the Orthopedic surgeon and the Pediatric urologist checked their patients for any potential disruptions and abnormalities, duly noting any anomalies. Findings: Upon follow-up, it was found that all the patients had entirely closed diastases and any previous gaps had diminished to mesh into continuity. The mean follow-up time was 2 years, but ranged from 4 months to 3 years depending upon the individual patient, the patients recovery progress and general well-being. Within 2 months, all osteotomies were noted to have been closed with diastases, which was a partial failure that merits rectification and is a 50% loss of correction. There was no rupture of the wound or bladder repair in any of the patients. The mean postoperative diastasis was 5.9 cm (range: 5.0 cm - 6.8 cm) and the mean postoperative diastasis was 2.6 cm to 5 cm at 12 cm. All patients' follow-up divulged complete postoperative urinary continence, as desired, and these findings were reaffirmed by the pediatric urologist, who noted that the patients now possessed satisfactory urinary continence. Conclusion: The use of external fixators and bilateral iliac osteotomies in our series has proven useful for obtaining a free closure tension and separation, which are ubiquitous postoperative complications that often thwart the desired repair.