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19–22 APRIL, 2017, BARCELONA, SPAIN
11:17–11:20
S7-7 (PP)
INGUINAL HERNIOTOMY IN CLASSIC BLADDER
EXSTROPHY
David KEENE, Doru NICOARA, Vytis KAZLAUSKAS , Alessandra SCALAS
and Raimondo CERVELLIONE
Royal Manchester Children’s Hospital, Paediatric Urology, Manchester, UNITED KINGDOM
PURPOSE
To determine the incidence of inguinal hernias in bladder exstrophy (BE) patients managed by
delayed staged exstrophy closure and compare the recurrence rates following surgery via an
inguinal or scrotal approach to existing literature (Stringer et al. Br J Urol;1994;73:308-9, Lavien et
al. J Pediatr Surg;2014;49:1496-99).
MATERIAL AND METHODS
Prospective database of all patients with classic BE operated since 2007 in a single institution.
Fishers exact test two-tailed analysis p<0.05. Gender, age at herniotomy and hernia recurrence
were the outcomes prospectively collected on consecutive patients with classic BE and inguinal
hernias between 2007 and 2016.
RESULTS
Sixty-three BE patients (19 female, 44 male) underwent 45 inguinal herniotomy procedures (9 bi-
lateral, 18 unilateral). The incidence of hernias in this cohort of BE patients was 59% in males and
5% in females. Twenty-one herniotomies were performed via an inguinal approach, 24 via a scrotal
approach; all unilateral hernias were right sided. Forty-one were performed pre or peri BE closure
and 7 recurred, 4 were performed post BE closure and none recurred. The recurrence rate was
not significantly different between the inguinal and scrotal approaches (P=0.3) and between those
described in the literature (Stringer & Lavien).
Present study
Lavien 2014
Stringer 1994
Number of herniotomies performed 45
70
45
Incidence
59.0% (M)*
5.2% (F)
69% (M)
8% (F)
86% (M)*
15% (F)
Recurrence (%)
22% (7 pre BEC,
0 post BEC)
17% (BEC with
osteotomy)
55% (BEC without
osteotomy)
17%
Mean follow up time (years)
4.4
8
5.9
*p=0.005
CONCLUSIONS
The incidence of inguinal hernias in boys is lower than that previously described (Stringer et al,1994)
which may be due to the authors using pelvic osteotomies routinely in all exstrophy patients, reduc-
ing de novo and recurrent inguinal hernia development post BE closure as suggested by Lavien et
al, 2014. Both the inguinal and scrotal approach are equally effective in treating the hernias.