O2212: Repeat Pelvic Osteotomy Improves the Management of Failed Bladder Closure in Cloacal Exstrophy

Background: We evaluated the operative benefits of repeat pelvic osteotomy in patients with cloacal exstrophy (CE) undergoing secondary or tertiary bladder closures.

Methods: CE patients undergoing secondary or tertiary closures between 1975-2025 were identified. Primary pelvic osteotomy was defined as the initial osteotomy, while repeat osteotomy referred to a subsequent osteotomy performed during reclosure. Patient demographics, surgical factors, and outcomes were collected.

Results: Among 35 secondary closures, 19 succeeded while 16 failed. A longer interval between primary and secondary closures was associated with higher success of secondary closures compared to failures (1.72 years vs. 0.64 years, p=0.0031). Primary and repeat pelvic osteotomies were significantly associated with successful secondary closures while secondary closures without osteotomy had higher failure rates (p=0.02). Regarding the type of osteotomy, combined vertical and transverse anterior innominate osteotomies were associated with higher successes in secondary closures, whereas posterior iliac-only osteotomies were more likely to result in failure (p=0.02). In terms of immobilization techniques, the use of Buck’s traction with external fixation improved success of secondary closures while the use of a spica cast led to a higher failure rate (p=0.02).

Conclusion: Repeat pelvic osteotomy enhanced secondary closure success in CE patients. Osteotomy techniques, particularly combined vertical iliac and transverse anterior innominate osteotomies, as well as the use of Buck’s traction with external fixation, were particularly beneficial. These findings suggest that repeat osteotomy, when appropriately utilized, can enhance surgical outcomes in complex CE management of secondary bladder closures.