Anterior component separation technique for abdominal closure in bladder exstrophy repair: Primary results



      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.


      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.


      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).


      Summary Figure 1
      Graphical AbstractAchievable length with separation of both sides. A: 3 cm extent of advance upon traction; B: Final aspect after midline closure with a 2 cm gain on each side; C: Another case in which an even larger extent of approximation was achieved.



      BE (Bladder exstrophy), ACS (Anterior component separation), PICU (Pediatric intensive care unit)
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