Laparotomy Incision Research Articles

Scar revision for persistent pain and activity limitation after exploratory laparotomy in infancy: A case series

AbstractExploratory laparotomy in neonates is typically performed via a transverse laparotomy incision. However, this incision may be complicated by poor cosmesis and scar contracture. In three patients, primary gastroenterologists identified significant scar contractures that resulted in pain and limitations with physical activity, necessitating surgical referrals. All patients required subsequent surgical revision of their scar, which involved creation of skin flaps, repair of abdominal wall hernias if present, and reapproximation of the subcutaneous tissue. We describe this phenomenon and the resultant need for surgical management to raise awareness of these late complications and suggest subcutaneous tissue reapproximation should be performed when possible during abdominal wall closure.

WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis

Abstract Background In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections. Method Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusion The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.

Treatment of the Buried Bumper Syndrome​​​​​: A Retrospective Multicenter Study With Inclusion of 160 Cases.

The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques. The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality. The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% (P<0.01), rates of overall technical success 100% and 88.3% (P=0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) (P<0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes (P<0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%. Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.

522 A Snapshot Audit of Incisional Hernia Rates Following Colorectal Cancer Resection

Abstract Aim Incisional hernia is a common complication of colorectal surgery. Recent European Hernia Society guidelines recommend strategies such as small bites closure and off-midline incisions to reduce incisional hernia rates. We aimed to evaluate our centres incisional hernia rate and performance against these categories Method All patients undergoing surgery for colorectal cancer in 2020 were included. Operative details including incision location and closure method were collected. Post-operative CT scans were assessed and correlated with clinic letters to determine presence of incisional hernia. Patients were excluded if they underwent re-operation through the midline within 12 months, or if had no imaging after 12 months. Results 118 patients were included. The incisional hernia rate was 31.4% at a mean follow-up of 24.9 months. Large bites closure (Hughes or loop PDS, n=80) had a higher incisional hernia rate compared to small bite closure ( n=38) (35.0% vs 23.6%). Incisional hernia rates were 44.1% in laparotomy incisions, 37.2% in midline extraction sites, 8% in Pfannensteil extraction sites and 0% in transverse extraction sites. Overall, IH rates in midline incisions were 40.7%, compared to 6.3% in off-midline incisions. Conclusions Incisional Hernia rates remain high following colorectal cancer surgery in our institution. Small bites closure and off-midline incisions appear to reduce this risk, but use of these techniques remains low. Work is ongoing to identify and implement strategies to improve uptake of small bites and off-midline incisions.

Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications.

Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the superficial layers. The celiotomy incision is protected by an elastic bandage during the immediate postoperative period. This technique has been associated with favorable results: 5.3% confirmed incisional infections after a single celiotomy and 26.7% after repeat celiotomy. The overall incisional complication (serous/sanguineous discharge, hematoma, infection, hernia formation, and complete wound breakdown) occurrence was 9.5% and 33.3% after single and repeat laparotomy, respectively. In cases considered more susceptible to infection (early relaparotomy or laparotomy incisions longer than 30 cm), negative pressure therapy was found easy to apply on closed incisions. No detrimental effects were observed. However, the potential prophylactic benefit of this therapy needs to be confirmed in a larger group. In infected laparotomy wounds requiring drainage, the use of negative pressure therapy seemed to have a positive effect on the formation of granulation tissue. However, there was no control group to allow statistical confirmation. Finally, one case of complete breakdown of the laparotomy incision was managed by stainless steel retention sutures, the application of negative pressure therapy, and a hernia belt. At re-evaluation 15 months post-surgery, several small hernias were detected, but the horse had returned to his previous level of sports performance and had not shown any episode of colic.

Gigantic adrenal pseudocyst: A case report

Adrenal cystic lesions are uncommon, non-functional, and asymptomatic. Adrenal Pseudocyst is a fibrous cyst devoid of any epithelial or endothelial lining. They have a female predominance with an incidence ratio of 3:1, usually occurring in the 3rd and 4th decade of life. We describe a case of a massive left-sided adrenal pseudocyst in a 50-year-old obese lady who had been experiencing stomach pain and distension for six months before her presentation. Investigations revealed a considerable cyst arising from the left adrenal gland. Excision via midline laparotomy incision was planned. Findings are discussed, including radiology, cytology, histology, and patient management. Adrenal Pseudocyst is a rare lesion, and imaging may mislead in diagnosis. Consider alternative diagnoses including benign and malignant masses of nearby organs, particularly the adrenal, kidney, and pancreas. After surgical excision, a pathological study is necessary for a conclusive diagnosis.

Herringbone stitch technique versus interrupted suturing technique for rectus closure in emergency laparotomy: A comparative study

Background: Midline laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. Secure abdominal wall closure after any laparotomy is every surgeon’s aim. Aims and Objectives: The aim of the study was to choose the better method of rectus closure by comparing the herringbone stitch technique with the interrupted suturing technique for rectus closure in emergency laparotomy. Materials and Methods: Fifty patients who underwent midline emergency laparotomy at MGM Medical College and MY Hospital, Indore, between January 2023 and April 2023 were included in our study. In 25 patients (Group A) herringbone stitch technique was used whereas in the other 25 patients (Group B) interrupted suturing technique for rectus closure was used and they were assessed based on the incidence of surgical site infection (SSI), superficial wound dehiscence, fascial dehiscence, and incidence of incisional hernia. Results: The incidence of SSI was comparable in both groups but the incidence of superficial wound dehiscence, fascial dehiscence, and incisional hernia is less in Group A. Conclusion: The herringbone stitch technique is better as compared to the interrupted suturing technique for rectus closure in emergency laparotomy.

A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

IntroductionNeonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications. MethodsA multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis. ResultsOverall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5). ConclusionsStoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.

Collating evidence to support the validation of a simulated laparotomy incision and closure-training model

BackgroundIt is essential to evaluate the functionality of surgical simulation models, in order to determine whether they perform as intended. In this study, we assessed the use of a simulated laparotomy incision and closure-training model by collating validity evidence to determine its utility as well as pre and post-test interval data. MethodThis was a quantitative study design, informed by Messick's unified validity framework. In total, 93 participants (surgical trainees ​= ​80, experts ​= ​13) participated in this study. Evaluation of content validity and the models' relationships with other variables was conducted, along with a pre and post-test confidence assessment. ResultsThe model was deemed realistic and useful as a teaching tool, providing strong content validity evidence. In assessment of relationships with other variables, the expert group out-performed the novice group conclusively. Pre and post-test evaluation reported a statistically significant increase in confidence levels. ConclusionWe present strong validity evidence of a novel laparotomy incision and closure simulation-training model.

An Update in the Management of “Frozen Abdomen”

With a 0.5–3% incidence following initial closure of a laparotomy incision, wound dehiscence is a significant postoperative complication that signifies an abrupt mechanical failure of wound healing. Both clinical entities have common pathophysiological and clinical processes, as recently as the idea of "intentional open abdomen" was defined ("postoperative open abdominal wall"). While early restoration is the goal, a considerable number of patients may experience adhesions between the anterolateral abdominal wall and abdominal viscera; this condition is commonly referred to as "frozen abdomen," and the only practical option seems to be to postpone wound closure. We provide the "Coliseum technique" as the last surgical approach to treat it. This new method offers a creative substitute for abdominal exploration in situations with frozen abdomen that is considered "malignant" because of peritoneal carcinomatosis. Lifting the surgical wound's edges upward and suspending them from a retractor above the abdomen with threads makes it easier to approach the peritoneal cavity, maximizes the exposure of internal organs, and reduces the risk of operating-related damage to the blood supply and innervation of the abdominal wall muscles, which is an essential step for hernia repair later on..

A Comparison of a Small-Stitch Closure With a Standard Closure in Midline Laparotomy Incisions: A Prospective Comparative Study.

Introduction Midline incision provides a rapid and thorough approach to the abdominal cavity and, therefore, is widely employed in both emergency and elective procedures. However, midline laparotomy is associated with many post-operative complications likewound dehiscence, incisional hernia, fistula formation, and surgical site infection (SSI). The purpose of the study is to comparethe complications that occurred post-operativelyin associationwith thelong and smallbite suture techniques for midline laparotomy incisions. Methodology A prospective comparative study was carried out among 90 cases of midline laparotomies for 18 months (January 2021 to June 2022). The participants were categorizedinto two groups: (1) Group A, which included 45 patients, underwent small-suture abdominal fascia closure, and (2) Group B, which consisted of the remaining45 patients, underwent large-suture abdominal midline wound closure. Patients were followed up in the hospital till the day of discharge and in the outpatient department (visit 1, within one month of surgery) for pain, wound dehiscence, and surgical site infection. Patients were called for visit 2 (six months post-surgery) and incisional hernia rates were assessed. Results On the numerical pain rating scale, the mean score was higher in Group B, that is, 4.1 than in Group A, which was 3.5. Wound dehiscence and incisional hernia rates were higher among Group B cases. The majority of SSIs were noted in Group B with statistically significant results. Conclusion Despite the lack of randomization,the results demonstrated in this study support the use of small bite sutures in comparison to long bite sutures for laparotomy closure.

Comparing the Efficacy of Povidone-Iodine Versus Normal Saline in Laparotomy Wound Irrigation to Prevent Surgical Site Infections: A Meta-Analysis.

Surgical site infections (SSIs) are a known complication of laparotomies and intra-abdominal surgical operations leading to remarkable consequences on mortality, morbidity, and expenses. The study aims to assess the efficiency of irrigating laparotomy incision sites with povidone-iodine (PVI) or normal saline (NS) in diminishing the rate of SSIs in patients undergoing gastrointestinal operations for varying indications. Randomized controlled trials (RCTs) highlighting the contribution of laparotomy wound irrigation with PVI in opposition to NS in patients planned for laparotomy addressing numerous gastrointestinal issues, and their role in reducing SSI risk were obtained via searching of standard electronic medical databases. The analysis was conducted by utilizing meta-analysis principles procured by statistical software RevMan version 5.3 (Cochrane Collaboration, London, UK). The yield of medical databases exploration and inspection was 13 RCTs on 3816 patients who underwent laparotomy for different gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations preceding closure of the laparotomy skin wound. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk (odds ratio = 0.54, 95%CI (0.30, 0.98), Z = 2.04, P = 0.04) of SSIs. Nevertheless, there was outstanding heterogeneity (Tau2=70; chi2=40.19, df=12; P = 0.0001; I2=70%) among the included studies. According to the comprehensive analysis outcomes, it has been clinically proven that the use of PVIis highly effective in reducing the occurrence of SSIs, as well as their subsequent implications.

Vascularized omental tissue transfer for the treatment of lymphedema: a review

Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system. In the Western world, lymphedema most often arises secondary to the treatment of malignancy. Patients with lymphedema experience progressive swelling, pain, numbness, and tingling, and decreased quality of life. Those with persistent symptoms may be subject to chronic cellulitis. The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant (VLNT). One donor region is the omentum. Vascularized omental lymph node transfer (VOLT) has been shown to decrease limb volume, circumference, and subjective symptoms of lymphedema. The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedema-related cellulitis. The omentum may be harvested laparoscopically, with robotic assistance, or through a small laparotomy incision. In this review, we describe the relevant anatomy and history of VOLT as well as operative techniques. The risks, benefits, and relevant outcome studies will be reviewed. Recent applications of robotic surgery to VOLT will be addressed.

Negative pressure wound therapy for emergency laparotomy incisions: A national database propensity matched study

BackgroundSurgical site infections (SSI) are a common complication of laparotomy incisions. The role of Negative Pressure Wound Therapy (NPWT) in preventing SSIs has not yet been explored in a nationwide analysis. We aimed to evaluate the association of the prophylactic use of NPWT with SSIs in patients undergoing an emergency laparotomy procedure. MethodsWe conducted a retrospective cohort study using the National Surgery Quality Initiative Program (NSQIP) database from 2013 to 2020. We included patients ≥18 years undergoing an emergency laparotomy. We performed a 1:1 propensity matching adjusting for patient age, sex, race, ethnicity, BMI, comorbid conditions, ASA status, diagnosis, preoperative factors and laboratory variables, procedure type, wound class, and intraoperative variables. We compared NPWT with standard dressings in two patient populations: 1. patients with completely closed (skin and fascia) laparotomy incisions and 2. patients with partially closed (fascia only) laparotomy incisions. Our primary outcome was the rate of incisional SSI. Secondary outcomes included the type of SSI, postoperative 30-day complications, postoperative hospital length of stay, and discharge disposition. ResultsWe included 65,803 patients with completely closed incisions of whom 387 patients received NPWT. There was no significant difference in the rate of total SSIs (13.4 ​% vs. 11.9 ​%; p ​= ​0.52) in the matched population of 387 pairs. We included 7285 patients with partially closed incisions of whom 477 patients received NPWT. There was no significant difference in the rate of total SSIs (3.6 ​% vs. 4.4 ​%; p ​= ​0.51) in the matched population of 477 pairs. Secondary outcomes did not differ significantly in either group. ConclusionThe rate of SSIs was not significantly different when prophylactic NPWT was used compared to standard dressings for patients with a closed or partially closed laparotomy incision.

Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The incidence of incisional hernias (IH) after midline laparotomy varies from 11% to 20%. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially prone to hernias because a Xiphoid to pubis laparotomy incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects. We performed a retrospective analysis on a prospectively maintained single institution database from March 2015 to July 2020. The inclusion criteria were patients who underwent CRS-HIPEC and had at least 6 months postoperative follow-up with post-operative cross-sectional imaging study. Two hundred and one patients were included in the study. All patients underwent CRS-HIPEC with resection of previous scar and umbilectomy. Fifty-four patients were diagnosed with IH (26.9%). The major risk factors for IH in multivariate analysis were higher American society of Anesthesiologists score (ASA) (OR 3.9, P = 0.012), increasing age (OR 1.06, P = 0.004) and increasing BMI (OR 1.1, P = 0.006). Most of the hernia sites were median (n = 43, 79.6%). Eleven (20.4%) patients had lateral hernias due to stoma incisions or drain sites. Most of the median hernias were at the level of the resected umbilicus 58.9% (n = 23). Five (9.3%) of the patients with IH necessitated an urgent surgical repair. We have demonstrated that more than a quarter of the patients after CRS-HIPEC suffer from IH and up to 10% of them may require surgical intervention. More research is needed to find the appropriate intraoperative interventions to minimize this sequela.

Commentary on 'Prophylactic negative pressure wound therapy for closed laparotomy incision after ventral hernia repair: A systematic review and meta-analysis'.

Wang, Jinjun MDa; Yu, Yuanyuan MDb; Huang, Xianming MDc; Chen, Xiguang MDd, Author Information

Stable and Efficient Animal Models of the Peritoneal Adhesion

AbstractPeritoneal adhesion (PA) is a widespread complication of surgery arising from physiological problems. Various therapies and medicines for anti‐PA have been studied but lack unified and standard PA models. Various experimental techniques are applied to establish and investigate reliable models for inducing PA in pigs and rats. This study utilizes four scoring systems to evaluate the severity of adhesions. In pigs, U‐shape incision, L‐shape incision, ileum resection, cecum abrasion &amp; peritoneum abrasion, and cecum purse‐string &amp; peritoneum abrasion models are established, to assess the impact of laparotomy incision and double opposed wound on adhesion formation. For rat models, the exposed double opposed wound models are created, including peritoneum resection &amp; cecum abrasion, peritoneum abrasion &amp; cecum abrasion, two knots &amp; cecum abrasion, and four knots &amp; cecum abrasion models, to explore the influence of double opposed wounds and foreign materials. The findings suggest that the peritoneum resection &amp; cecum abrasion model is a reliable and reproducible PA model, as it exhibits a high adhesion rate and consistent adhesion scores across all evaluation approaches. The utilization of the double‐opposed wound model and evaluation systems contributes to more scientifically rigorous and efficient preclinical evaluations of various anti‐adhesion agents.

WITHDRAWN: Cholelithiasis in Childhood: Report of two cases from Afghanistan and literature review

Mesenteric cysts are uncommon intra-abdominal benign masses that appear in childhood with varying degrees of clinical manifestations, ranging from being asymptomatic to presenting as an acute abdomen. The diagnosis is made incidentally during the work-up for other abdominal pathologies like acute appendicitis, bowel obstruction, etc. The treatment is mostly surgical and varies depending on the clinical type of the lesion. A 26-month-old child was referred to our teaching hospital's pediatric surgery department with an abdominal mass. The patient had previously complained of constipation and been treated symptomatically with laxatives. Following the diagnostic work-up such as ultrasonography (USG) and computerized tomography scanning (CT-scan), the patient was misdiagnosed as having ovarian cysts, but during the surgical procedure she was found to have a duplex cyst, which was mostly incorporated in the mesentery of the distal 1/3 of the transverse mesocolon. We prepared the patient for definite treatment, and the cyst was enucleated through a lower midline laparotomy incision without bowel resection and anastomosis. The histopathological analysis of the specimen confirmed a mesenteric cyst. Mesenteric cysts are rare lesions in children and should be considered when approaching any intra-abdominal mass. Except for the rare cases where intestinal resection and/or partial cyst excision are required, all mesenteric cysts can be excised while preserving intestinal integrity and vascular supply.

Patient-specific computational simulations of wound healing following midline laparotomy closure.

In the current study, we developed a new computational methodology to simulate wound healing in soft tissues. We assumed that the injured tissue recovers partially its mechanical strength and stiffness by gradually increasing the volume fraction of collagen fibers. Following the principles of the constrained mixture theory, we assumed that new collagen fibers are deposited at homeostatic tension while the already existing tissue undergoes a permanent deformation due to the effects of remodeling. The model was implemented in the finite-element software Abaqus® through a VUMAT subroutine and applied to a complex and realistic case: simulating wound healing following midline laparotomy closure. The incidence of incisional hernia is still quite significant clinically, and our goal was to investigate different conditions hampering the success of these procedures. We simulated wound healing over periods of 6months on a patient-specific geometry. One of the outcomes of the finite-element simulations was the width of the wound tissue, which was found to be clinically correlated with the development of incisional hernia after midline laparotomy closure. We studied the impact of different suturing modalities and the effects of situations inducing increased intra-abdominal pressure or its intermittent variations such as coughing. Eventually, the results showed that the main risks of developing an incisional hernia mostly depend on the elastic strains reached in the wound tissue after degradation of the suturing wires. Despite the need for clinical validation, these results are promising for establishing a digital twin of wound healing in midline laparotomy incision.

Complete bladder duplication presenting in adulthood: A case report on reconstructive technique and reflections on translational urology in refugees

Introduction and aim of studyThe bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of congenital malformations with many variations. A never operated political refugee with BEEC was referred to our center for management upon arrival in Europe. Our aim is to report the technique and outcomes on a never operated on BEEC adult, highlighting the importance of transitional urologic care for congenital malformations in adult patients.Materials and methodsA 27-year old female patient was referred to our center for complete incontinence since birth by the General practitioner from the refugee center who suspected BEEC. Upon further investigation, an exstrophic bladder with blind ending ureteral orifices and a urethral meatus caudal to the exstrophic bladder plate were highlighted. A second non-exstrophic bladder with two orthotopic ureters was demonstrated, thereby a bladder duplication in the sagittal plane was diagnosed, presenting a wide-open bladder neck and a 7 cm pubic diastasis, causing the incontinence she was initially referred for. With the patient in a supine position, laparotomy incision was done with excision of the umbilical scar. The exstrophic bladder plate is dissected caudally. As it presents good detrusor quality, decision is taken to use it as a ventral inlay to augment the non-exstrophic bladder. A Mitchell-type bladder neck reconstruction is performed with a classical fascia sling wrapped around the bladder neck to increase the continence mechanism given the very wide pubic diastasis. Given the risk for hyper-continence, interposition of a continent Mitrofanoff-type vesicostomy is additionally realized. Genital reconstruction is achieved.ResultsOver 1 year post operatively, the patient is completely dry, can holp up to 250ml between catheterization she performs five times per day and once at night. No post-operative complications were observed.ConclusionThe case of one adult patient with a rare urological condition like bladder exstrophy with duplication is presented, illustrating challenges political refugees referred to Europe implicates in terms of surgery regarding congenital malformations in adult patients. A multidisciplinary approach is highly important, demonstrating the importance of transitional care.