Pelvic osteotomy in cloacal exstrophy: A changing perspective

•What is currently known about the topic?•The method for osteotomy and pelvic fixation in cloacal exstrophy patients is an important, yet highly variable aspect of successful closure.•What new information is contained in the article?•Trends in osteotomy type and fixation methods are evaluated since the 1960s. Patients who underwent combination osteotomy in a staged approach had the highest rates of successful primary closure. The type of osteotomy and pelvic fixation in the management of primary cloacal exstrophy (CE) closure is variable. The purpose of this study was to evaluate primary CE closure outcomes with osteotomy, immobilization, and multi-staging procedure trends over time. An institutional database was retrospectively reviewed for patients who underwent primary CE closure from 1960 to 2020. Demographics, osteotomy, fixation, and outcomes were noted. Subanalyses by location of primary closure (AH=author's hospital; OH=outside hospital). Out of 122 patients, multi-stage became more common than single-stage procedures (p = 0.019), with multi-stage associated with higher success rates (77.4% v 45.7%; p = 0.001). The use of any osteotomy increased over time (p = 0.007), with a posterior approach falling out of favor and increasing prevalence of a combined osteotomy (p