Delayed primary closure of bladder exstrophy without osteotomy: 12 year experience in a safe and gentle alternative to neonatal surgery

•What is currently known about this topic?•Primary bladder closure in patients with CBE is mainly performed in specialist centers. There is still an ongoing debate on the time and type of closure and on the need of pelvic osteotomy for successful bladder closure. Especially osteotomy is associated with long hospital stays.•What new information is contained in this article?•Delayed primary closure in patients with CBE is safe procedure, which can be routinely performed without osteotomy. The major advantage of continuous epidural blockage could be confirmed. Successful primary closure of bladder exstrophy is of utmost importance for bladder capacity and urinary continence. We evaluated our concept of delayed primary closure that challenges the role of neonatal surgery, pelvic osteotomy, and perioperative pain management. We reviewed the medical records of patients with classic bladder exstrophy (CBE) who had undergone delayed primary closure without osteotomy at our institution between January 2008 and May 2020. Data to be analyzed included patient demographics, intraoperative pelvic laxity, blood transfusion, postoperative ventilation time, requirement of pain medication, time to full feeds, length of ICU stay, postoperative complications, and total hospital stay. 66 patients (44 boys) met the inclusion criteria. Mean age at surgery was 64.8 days (SD±24.7). Pelvic approximation