With various degrees of involvement, the exstrophy-epispadias complex continues to challenge treating reconstructive pediatric urologists and surgeons. The modern staged repair of exstrophy remains a reliable surgical technique in restoring form and function to these children. Through a staged approach, children are historically well positioned for ultimate success in closure, with many now entering middle adulthood. The nuances of this technique, along with special considerations, are reviewed, including the indications for pelvic osteotomy as well as strategies for lower limb immobilization. Finally, future research and directions of this technique are included to emphasize the evolution the staged approach will continue to undergo.