Novel Surgical Approaches to Neo-Umbilicoplasty in the Setting of Bladder Exstrophy
Eric R. Anderson, BS1, Jessica T. Goetz, DO1, Jennifer R. Fraizer, MPH1, Bryn S. Sack, MD2, Travis W. Groth, MD1, Douglas A. Canning, MD3, Aseem R. Shukla, MD3, Dana A. Weiss, MD3, Michael E. Mitchell, MD1, Joseph G. Borer, MD2, John V. Kryger, MD1, Elizabeth B. Roth, MD1.
1Children's Hospital of Wisconsin, Milwaukee, WI, USA, 2Boston Children's Hospital, Boston, MA, USA, 3Children's Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: The umbilicus defines the abdomen. An atypical umbilicus can distress the patient and their caregivers. There is no standardized approach to neo-umbilicoplasty(NU) for bladder exstrophy(BE). Other authors have reported patients left with flat, featureless scars rather than the expected, superiorly hooded umbilicus with aesthetic depth. We present three, novel NU techniques for BE and short-term surgical outcomes. METHODS: Patients with BE presenting at a member institution were prospectively consented and enrolled in the Multi-Institutional Bladder Exstrophy Consortium (MIBEC). MIBEC institutions recorded surgical video during classic BE repair to include representative NU techniques. Our three most implemented techniques (Circular Free-Graft, S-Flap and Trapezoid Flap) were described. We recorded short-term outcomes data including times utilized, and revisions required (with indications). RESULTS: Our consortium has performed thirty-two circular free graft NU, seven S-flap NU, eleven trapezoid flap NU and three alternative technique NU. Two free grafts required revision due to dysmorphic neo-umbilici. No other technique required revision. In all cases, NU creation was successful, no procedures were aborted and there were no reported immediate postoperative complications such as hematoma, seroma, infection or necrosis of the NU. CONCLUSIONS: These three novel NU are simple, minimally invasive techniques which, based on short-term outcomes data, reproducibly produce aesthetically pleasing NU.
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