Staged closure of the pelvis in secondary repair of cloacal exstrophy in the older patient

The authors describe a staged approach for pelvic closure applied in preadolescents and adolescents with previously failed closure of cloacal exstrophy. Closure of the pelvis was performed in four patients, 11 to 16 years old, with history of previous closures for their cloacal exstrophy that had resulted in either dehiscence or severe disfigurement. They were treated with pelvic osteotomies and external fixation; three later underwent internal fixation of the pubic rami. Genitourinary reconstructions were performed with the final stage of pelvic ring closure. Genitourinary closure was successful in all four patients despite a recurrent pubic diastasis resulting from sacroiliac joint instability in the patient not receiving internal fixation. Staged closure of the pelvis with iliac osteotomies, external fixation, gradual correction, and subsequent internal fixation of the approximated pubic rami can facilitate soft tissue closure of preadolescents and adolescents with unacceptably closed cloacal exstrophy.