Neonatal closure of bladder exstrophy

Abstract

The ureteric orifices are identified and stented. Large mucosal polyps are excised and mucosa is repaired. A midline incision is made, starting above the umbilical cord, encircling it and extending on each side on the mucosal edge of the bladder up to the level of the verumontanum. The edge of bladder is partially mobilised and bladder closure is started from the dome with interrupted inverting sutures. A stent is placed across the bladder neck and secured before the closure of the bladder. The abdominal muscles are mobilised off the skin and apposed with interrupted horizontal mattress sutures starting from the upper part of the wound. In the lower part of the wound, the sutures are applied and put on crossover traction to stretch the pelvic ligaments, and tied in turn while maintaining traction to approximate the pelvis. The skin and subcutaneous tissue are approximated. Epidural analgesia and enteral nutrition are key to postoperative pain management and healing.