Bladder exstrophy is a rare congenital abnormality of the genitourinary tract involving a severe midline abdominal wall defect, wide separation of the pubic symphysis, and an anteriorly positioned open bladder. A major reconstructive surgical repair with a prolonged postoperative course, often undertaken in the neonatal period, ensures optimal surgical success but poses significant unique challenges for perioperative anesthetic and pain management. This chapter provides an overview of the interdisciplinary perioperative management for the bladder exstrophy-epispadias complex, especially in relation to an anesthesiology-based perioperative team.