The ladder of learning in exstrophy closure — A 5 year initial faculty experience

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1 Scopus citations


Purpose: Closure of bladder exstrophy is one of the most complex reconstructive procedures. Basic concepts of these operations, as well as their subtle nuances, require years of experience. However, the volume of these cases is low. The authors describe the experience of a junior surgeon learning the details of exstrophy closure during fellowship and her initial career. Methods: Fellows graduating in 2014 were surveyed for their exstrophy experience during fellowship and the following four years. Operative logs of the junior faculty member were reviewed during the same time. Average operative times were calculated for each year. Results: Seventeen of the 25 fellows responded to the survey. Eight surgeons did one or fewer exstrophy closures during fellowship; 14 did one or fewer closures as an attending. The junior faculty member assisted in 18 closures as a fellow and 48 exstrophy closures during the next four years. Average operative time decreased from 485 to 309 min from attendingship year one to four. Conclusions: There are subtle details inside and outside of the operating room required to ensure a successful outcome in this important step of exstrophy reconstruction. Working alongside senior colleagues is essential to allow the junior surgeon to ascend this ladder of mastering exstrophy closure. Type of study: Diagnostic.

Original languageEnglish (US)
Pages (from-to)1542-1545
Number of pages4
JournalJournal of pediatric surgery
Issue number8
StatePublished - Aug 2020


  • Bladder exstrophy
  • Pediatric urology
  • Surgical education
  • Urology fellowship

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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