The dual-staged pathway for closure in cloacal exstrophy: Successful evolution in collaborative surgical practice.
J Pediatr Surg
; 54(9): 1761-1765, 2019 Sep.
Article
en En
| MEDLINE
| ID: mdl-31003729
ABSTRACT
INTRODUCTION:
A successful abdominal wall and bladder closure is critical in the management of cloacal exstrophy (CE). This study examines closure outcomes and practices over the last 4 decades at the authors' institution. Beginning in 1995, the authors' institution standardized CE closure and management with the Dual-Staged Pathway (DSP). The DSP consists of a staged bladder closure, a staged or concurrent osteotomy, and postoperative immobilization with external fixation. The authors hypothesize that the DSP has provided better outcomes in CE closures.METHODS:
A prospective database of 1332 Exstrophy-Epispadias Complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. The DSP consists of a staged osteotomy and a staged bladder closure in CE patients with a diastasis greater than 4â¯cm. To evaluate the DSP, outcomes of closure at the authors' institution were compared between two equal, twenty-year periods before and after its implementation. Data on timing of closure, postoperative management, surgical complications, and outcomes were collected.RESULTS:
There are 142â¯CE patients in the database. In this study, 49â¯CE patients with 50 closures met inclusion criteria. The overall success rate of closures from 1975 to 1994 was 88% (14 of 16), while the success rate of the DSP was 100% (nâ¯=â¯34), pâ¯=â¯0.098. Twenty-two (65%) primary and 12 (35%) secondary closures were performed using the DSP. Overall complication rates of the DSP remained similar to previous closures, (29% vs 19%, pâ¯=â¯0.508). Since incorporation of the DSP, patients referred for closure have generally had a larger preclosure diastasis (7.2â¯cm vs 5.1â¯cm, pâ¯=â¯0.011).CONCLUSION:
The standardized DSP closure has proven successful in 34 primary and reoperative cloacal closures in the past 20â¯years. With this approach, the authors feel that the DSP offers greater patient safety and better outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Procedimientos Quirúrgicos Urológicos
/
Extrofia de la Vejiga
Tipo de estudio:
Observational_studies
Límite:
Humans
Idioma:
En
Revista:
J Pediatr Surg
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos