Interim report in humans of a previously described technique in an animal model: closure of bladder exstrophy with rectus abdominis muscle flap-II.

The results of a new bladder closure and augmentation technique in children born with bladder exstrophy are reported. The technique was performed in 6 children, including 4 who had, in addition to a small, inelastic, noncompliant bladder, squamous epithelial metaplasia and polypoid transformation. In the remaining 2 patients this technique was used after failed primary closures. A full thickness left rectus abdominis island flap containing skin, fascia, muscle and peritoneal layers is prepared with an intact neurovascular pedicle from the inferior epigastric artery. This flap is rotated to cover the bladder defect and aid in augmentation. The inner layer formed by peritoneum is sutured to the edges of the bladder defect. Postoperative endoscopic and histopathological investigations revealed the inner peritoneal layer of the flap to be completely covered by transitional bladder epithelium. No major surgical complications occurred in these 6 cases. Considering the advantages of the technique from this limited experience, evidence suggests that there is no need for a major gastrointestinal operation for bladder augmentation, since an acceptable bladder capacity was available. There was no mucus production from the inner layer of the flap, and metabolic and electrolyte disturbances were reduced.