title: Multiple failed closure of bladder in children with vesical exstrophy: Safety and efficacy of temporary ileal patch augmentation in assisting bladder closure.
abstract: OBJECTIVE
  The surgical approach to small bladder template in exstrophy bladder is difficult. Previously, many of these children underwent ureterosigmoidostomy and in recent times, the trend is to do a delayed primary closure. We have used ileal patch as a temporary cover for these small bladders with a view to encourage bladder growth and early results are encouraging.
  
  
  METHODS
  In five of the 45 children with bladder exstrophy managed by radical soft-tissue mobilization over 10 years, primary bladder closure was not possible due to repeated failed closures. A detubularized ileum was used to patch the bladder initially and after 4 months the patch was excised and bladder closure with sphincter repair was done in second stage.
  
  
  RESULTS
  In five children (three girls and two boys) the mean age at initial bladder closure was 14 months and mean age at ileal patch was 22 months. In four patients, the bladder grew facilitating closure and in one patient it failed. There were no complications with the use of gut in patch.
  
  
  CONCLUSIONS
  A temporary ileal patch seems promising in managing failed bladder closure in exstrophy patients. Long-term studies are needed before such a technique can be used in all patients with failed primary bladder closures.
authors.affiliation: Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India ; Department of Child and Adolescent Health, Baby Memorial Hospital, Calicut, Kerala, India.
authors.forename: Kolar Venkatesh Satish
authors.initials: KV
authors.lastname: Kumar
authors.affiliation: Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India.
authors.forename: Abraham
authors.initials: A
authors.lastname: Mammen
authors.affiliation: Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India.
authors.forename: Karthikeya K
authors.initials: KK
authors.lastname: Varma
keywords: Bladder exstrophy; delayed primary bladder closure; failed primary bladder closure; radical soft-tissue mobilization; temporary ileal patch augmentation