Francisco Nicanor Araruna Macedo1, Eduardo Corrêa Costa2, Jovelino Quintino de Souza Leão3, Antônio Carlos Amarante4, Fernanda Ghilardi Leão5, Hélio Buson Filho6, Marcelo Costamilan Rombaldi7, Augusto Cesar Gadelha de Abreu Filho8, Rossano Kepler Alvim Fiorelli9, Leandro Totti Cavazzola10, José Carlos Fraga11. 1. Pediatric Surgery Unit, Hospital da Criança, Rua Luiz Beltrão, 147, 21330-400, Rio de Janeiro, Brazil; Department of Surgery, Universidade Federal Do Estado Do Rio de Janeiro, Avenida Pasteur, 296, 22290-240, Rio de Janeiro, Brazil. Electronic address: nicanormacedo@hotmail.com. 2. Pediatric Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Sala 600, 90035-007, Porto Alegre, Brazil; Pediatric Surgery Unit, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, 90035-000, Porto Alegre, Brazil. Electronic address: eccosta@hcpa.edu.br. 3. Pediatric Urology Unit, Hospital Infantil Darcy Vargas, Rua Dr. Seráfico de Assis Carvalho, 34, 05614-040, São Paulo, Brazil. Electronic address: jovelino@uol.com.br. 4. Pediatric Urology Unit, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070, 80250-060, Curitiba, Brazil. Electronic address: antonio.amarante@gmail.com. 5. Pediatric Urology Unit, Hospital Infantil Darcy Vargas, Rua Dr. Seráfico de Assis Carvalho, 34, 05614-040, São Paulo, Brazil. Electronic address: fernandaghilardi@yahoo.com.br. 6. Department of Urology, Hospital da Criança de Brasília José de Alencar, AENW 3, Lote A, 70684-831, Brasília, Brazil. Electronic address: hbuson@gmail.com. 7. Pediatric Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Sala 600, 90035-007, Porto Alegre, Brazil. Electronic address: mcrombaldi@gmail.com. 8. Pediatric Surgery Unit, Hospital Infantil Albert Sabin, Rua Tertuliano Sales, 544, 60410-790, Fortaleza, Brazil. Electronic address: augustoabreufilho@gmail.com. 9. Department of Surgery, Universidade Federal Do Estado Do Rio de Janeiro, Avenida Pasteur, 296, 22290-240, Rio de Janeiro, Brazil. Electronic address: fiorellirossano@hotmail.com. 10. General Surgery Unit, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Sala 600, 90035-007, Porto Alegre, Brazil; Department of Surgery, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2400, 0035-002, Porto Alegre, Brazil.. Electronic address: cavazzola@gmail.com. 11. Pediatric Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Sala 600, 90035-007, Porto Alegre, Brazil; Department of Surgery, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2400, 0035-002, Porto Alegre, Brazil.. Electronic address: fraga.jcs@gmail.com.
Abstract
INTRODUCTION: Bladder exstrophy (BE) is a rare, complex malformation. There are three major approaches to closure. Despite this choice, abdominal wall closure in such patients is usually a challenging procedure specially in large defects and redo cases. OBJECTIVE: Our aim is to present our ten first cases' results, using Anterior Component Separation (ACS) to abdominal wall closure in BE patients. STUDY DESIGN: Ten male patients with BE (median age 7 months, range from 3 to 24 months) were operated from March 2020 to March 2021 by a multi-institutional Brazilian group using the Kelly technique. In addition to BE correction, anterior component separation was performed for abdominal closure. RESULTS: Postoperative suprapubic fistulae occurred in two of ten patients, but both closed spontaneously. No evisceration, abdominal wall dehiscence, or herniation was observed at a mean follow-up time of 14 months (range from 10 to 22 months). A 3 cm extent of advancement is achievable upon traction in each side (Fig. 3). CONCLUSION: We proposed the use of anterior component separation as an alternative for abdominal closure after BE correction using the Kelly procedure. This new technique avoids mesh usage, loosens the abdominal wall tension, and reduces complications. Even However, further studies are required.
INTRODUCTION: Bladder exstrophy (BE) is a rare, complex malformation. There are three major approaches to closure. Despite this choice, abdominal wall closure in such patients is usually a challenging procedure specially in large defects and redo cases. OBJECTIVE: Our aim is to present our ten first cases' results, using Anterior Component Separation (ACS) to abdominal wall closure in BE patients. STUDY DESIGN: Ten male patients with BE (median age 7 months, range from 3 to 24 months) were operated from March 2020 to March 2021 by a multi-institutional Brazilian group using the Kelly technique. In addition to BE correction, anterior component separation was performed for abdominal closure. RESULTS: Postoperative suprapubic fistulae occurred in two of ten patients, but both closed spontaneously. No evisceration, abdominal wall dehiscence, or herniation was observed at a mean follow-up time of 14 months (range from 10 to 22 months). A 3 cm extent of advancement is achievable upon traction in each side (Fig. 3). CONCLUSION: We proposed the use of anterior component separation as an alternative for abdominal closure after BE correction using the Kelly procedure. This new technique avoids mesh usage, loosens the abdominal wall tension, and reduces complications. Even However, further studies are required.