Paul D. Sponseller, MD and Andy Zhu
The exstrophy-epispadias complex is a congenital condition describing a spectrum of disorders that affect the genitourinary tract, musculoskeletal system, and, in some cases, the intestinal tract.
Although no absolute consensus exists regarding the optimal osteotomy type to be used in surgical correction of CBE, a procedure commonly used in the modern era is the anterior innominate osteotomy proposed by Sponseller et al. The anterior osteotomy derives its inspiration from the Salter innominate osteotomy, which was devised in 1961 to correct congenital dislocation and subluxation of the hip.
Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children older than 6 months old, and (e) no requirement to turn the patient during the operation. Furthermore, if radiographic imaging does not show complete reduction of the symphyseal diastasis 7–10 days postoperatively, the external fixator bars can be used to gradually approximate the pubic rami over several days.
In summary, the primary goals of anterior innominate osteotomy in patients with exstrophy are to reduce the tension in the closed bladder and the abdominal wall and possibly to promote continence by restoring the fibrous symphyseal bar and the pelvic floor muscles. These goals can be achieved in the majority of patients.
In this submitted VJO segment, Dr. Paul D. Sponseller will review the history, indications, complications and outcomes along with footage of his surgical technique. VJO wishes to thank Dr. Sponseller and resident Andy Zhu for this presentation.
- Total Run Time: 18:42 minutes
- Catalog Number: 4079
- VJO Publication Date: November, 2012