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...
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| Veröffentlicht in: | Journal of pediatric surgery 2023-03, Vol.58 (3), p.478-483 |
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| creator | Haney, Nora M Crigger, Chad B Sholklapper, Tamir Mudalegundi, Shwetha Griggs-Demmin, Angelica Nasr, Isam W Sponseller, Paul D Gearhart, John P |
| description | •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 |
| doi_str_mv | 10.1016/j.jpedsurg.2022.06.020 |
| format | Article |
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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<0.001). The use of any osteotomy compared to no osteotomy was associated with successful closure (77.6% v 41.7%; p = 0.007). The combined, posterior, and anterior approaches were associated with 90%, 76.2%, and 60.9% successful primary closure rates, respectively (p<0.001). Fixation modalities changed over time as Buck's traction (p<0.001) and external fixation (p<0.001) became more prevalent. Spica casting has become less common (p = 0.0002). Immobilization type was associated with success rates with Buck's (92.1%; p<0.001) and external fixation (86.0%; p<0.001) performing best.
The use of osteotomy and fixation in the CE spectrum has changed markedly. In this cohort, a staged approach with combination osteotomy was associated with better outcomes when using a multidisciplinary team approach.
This is a retrospective comparative study (Type of Study: Treatment; Evidence Level: III)]]></description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2022.06.020</identifier><identifier>PMID: 35906108</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bladder Exstrophy - surgery ; Bony pelvis ; Cloacal exstrophy ; Fixator ; Humans ; Infant ; Osteotomy ; Pelvis ; Plastic Surgery Procedures ; Retrospective Studies ; Trends ; Urologic Surgical Procedures - methods</subject><ispartof>Journal of pediatric surgery, 2023-03, Vol.58 (3), p.478-483</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-da53078ce30105b5c736aa733986d6cfdbdc6e34263a237b33cbde2341c573463</citedby><cites>FETCH-LOGICAL-c368t-da53078ce30105b5c736aa733986d6cfdbdc6e34263a237b33cbde2341c573463</cites><orcidid>0000-0001-7127-4322 ; 0000-0002-1848-5259 ; 0000-0001-5366-8256 ; 0000-0002-8403-7198 ; 0000-0002-2059-1966</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022346822004468$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35906108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haney, Nora M</creatorcontrib><creatorcontrib>Crigger, Chad B</creatorcontrib><creatorcontrib>Sholklapper, Tamir</creatorcontrib><creatorcontrib>Mudalegundi, Shwetha</creatorcontrib><creatorcontrib>Griggs-Demmin, Angelica</creatorcontrib><creatorcontrib>Nasr, Isam W</creatorcontrib><creatorcontrib>Sponseller, Paul D</creatorcontrib><creatorcontrib>Gearhart, John P</creatorcontrib><title>Pelvic osteotomy in cloacal exstrophy: A changing perspective</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description><![CDATA[•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<0.001). The use of any osteotomy compared to no osteotomy was associated with successful closure (77.6% v 41.7%; p = 0.007). The combined, posterior, and anterior approaches were associated with 90%, 76.2%, and 60.9% successful primary closure rates, respectively (p<0.001). Fixation modalities changed over time as Buck's traction (p<0.001) and external fixation (p<0.001) became more prevalent. Spica casting has become less common (p = 0.0002). Immobilization type was associated with success rates with Buck's (92.1%; p<0.001) and external fixation (86.0%; p<0.001) performing best.
The use of osteotomy and fixation in the CE spectrum has changed markedly. In this cohort, a staged approach with combination osteotomy was associated with better outcomes when using a multidisciplinary team approach.
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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<0.001). The use of any osteotomy compared to no osteotomy was associated with successful closure (77.6% v 41.7%; p = 0.007). The combined, posterior, and anterior approaches were associated with 90%, 76.2%, and 60.9% successful primary closure rates, respectively (p<0.001). Fixation modalities changed over time as Buck's traction (p<0.001) and external fixation (p<0.001) became more prevalent. Spica casting has become less common (p = 0.0002). Immobilization type was associated with success rates with Buck's (92.1%; p<0.001) and external fixation (86.0%; p<0.001) performing best.
The use of osteotomy and fixation in the CE spectrum has changed markedly. In this cohort, a staged approach with combination osteotomy was associated with better outcomes when using a multidisciplinary team approach.
This is a retrospective comparative study (Type of Study: Treatment; Evidence Level: III)]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35906108</pmid><doi>10.1016/j.jpedsurg.2022.06.020</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-7127-4322</orcidid><orcidid>https://orcid.org/0000-0002-1848-5259</orcidid><orcidid>https://orcid.org/0000-0001-5366-8256</orcidid><orcidid>https://orcid.org/0000-0002-8403-7198</orcidid><orcidid>https://orcid.org/0000-0002-2059-1966</orcidid></addata></record> |
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| ispartof | Journal of pediatric surgery, 2023-03, Vol.58 (3), p.478-483 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Bladder Exstrophy - surgery Bony pelvis Cloacal exstrophy Fixator Humans Infant Osteotomy Pelvis Plastic Surgery Procedures Retrospective Studies Trends Urologic Surgical Procedures - methods |
| title | Pelvic osteotomy in cloacal exstrophy: A changing perspective |
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