ESPU Congress 2018 - Abstract Book

136

CONGRESS OF THE ESPU

14:50–14:53

S17-6 (PP)

INGUINAL HERNIA WITH BLADDER EXSTROPHY (BE):

MULTICENTRIC EXPERIENCE

Alfredo BERRETTINI

, Paolo CAIONE

, Gianantonio MANZONI

, Laura DEL

PRETE

and Marco CASTAGNETTI

1) Ospedale Maggiore Policlinico, Fondazione Cà Granda, Paediatric Urology Unit, Milan, ITALY - 2) "Bambino Gesù"

Children's Hospital, Research Institute, Division of Pediatric Urology, Dept. of Surgery, Rome, ITALY - 3) University

Hospital of Padua, Section for Paediatric Urology, Padua, ITALY

PURPOSE

Inguinal hernias are common in BE patients but there is no consensus on the ideal “timing” and

surgical strategy for its repair and whether repair during initial bladder closure (IBC) might prevent

risk of complications related to the hernia later in life. Multicentric experience in three tertiary centers

is reported.

MATERIAL AND METHODS

We retrospectively reviewed data of 36 patients (30 male-83 %) who underwent primary BE repair

from 2009–2016. Patients who had undergone initial surgery at other centers were excluded.

RESULTS

Hernia was repaired during IBC in 9/36 (25 %) patients at a median age of 47 (0–598) days. A pre-

peritoneal approach was used in 7/9 (77 %) patients, a canalicular or sub-canalicular approach

in 1 patient each respectively. One patient developed unilateral testicular atrophy after bilateral

sub-canalicular approach. 13/36 (36 %) patients underwent a delayed hernia repair at a median

age of 475 (16–1107) days including 11 undergoing an inguinal repair and 2 a laparoscopic ap-

proach. In 14 cases, including all the 6 females, initial hernia repair was not performed. Of these,

4/8 males (50 %) needed urgent surgical exploration for incarceration at a median 174 (45–329)

days from IBC. In none of the patients, a hernia recurrence was observed after a follow-up of

42 months(13–117).

CONCLUSIONS

Hernia repair during IBC is an effective option and a preperitoneal approach is safe. We observed

1 testicular atrophy after one inguinal hernia repair. Delayed surgery is feasible but further in-

creases the number of surgeries and the risk of hernia incarceration is high in the untreated males.

Recurrence risk is low in all of patients.

Gender/

Median

Age (days)

Surgical

approach Complications Incarceration

(N)

Recurrence

Surgical

management

Contestual

repair

9 9 M/12,4

6 Preperitoneal

2 inguinal

1 Unilat

testicular

atrophy

(controlateral

side)

1 mixed

Delayed 13 13 M/475 11 inguinal

2 laparoscopic

No hernia 14

8 M

4 (50 %)

6 F