WOFAPS 2025 8th World Congress of Pediatric Surgery

Background:
The Exstrophy-epispadias complex (EEC) is rare variant of full thickness infra umbilical anterior abdominal wall defect involving urinary bladder, external genitalia, pelvic bone, anorectum and perineum muscle. Incidence of spectrum of the EEC can be approximate at 1 in 10,000 births with male predominance. Diagnosis is obvious and managed surgically. Because of poor health care facility and lack of trained health care staff in rural area most of our patients referred to the tertiary center at the age of 1 to 2 months. Over last 30 years of clinical experience we focused on a simplified and effective approach suited to solve the problem with limited resource.

Objective:
To introduced a relatively safe and effective management protocol focused on soft tissue mobilization. .

Methods:
Patients were managed with a two-stage repair strategy initiated after 3 months of age. The surgical procedure involved transperitoneal soft tissue mobilization focused on bladder neck and intra-pubic bar of soft tissue without osteotomy.

Results:
Out of the 265 patients, 110 (41%) achieved good continence (dry for 2–3 hours during the day), 125 (47%) had partial continence, and 30 (11%) required a Mitrofanoff procedure for total incontinence. Cosmetic outcomes were satisfactory. Common complications included wound infections, bladder prolapse, and fistulas.

Conclusion:
Bladder exstrophy, though complex, is not life-threatening and can be effectively managed with a simplified surgical approach. A two-stage repair using soft tissue mobilization yields good outcomes in cosmesis and continence while preserving renal function. This technique is adaptable, cost-effective, and suitable for both primary and failed cases, making it ideal for application in developing healthcare systems.