Inguinal hernias associated with bladder exstrophy.

Abstract

OBJECTIVE: To determine the incidence and complications of inguinal hernias in patients with bladder exstrophy. PATIENTS AND METHODS: A retrospective review of inguinal hernias and their management in 70 consecutive patients (50 boys and 20 girls) with bladder exstrophy managed by staged reconstruction. Follow-up data were available for 69 patients. RESULTS: During a mean follow-up period of 5.9 years (range 0.3-14), 42 (86%) boys and three (15%) girls developed inguinal hernias. These were bilateral in 35 (78%) cases. All but three of these patients presented during infancy. In girls, no instance of incarceration or recurrence was noted. In contrast, 14 (29%) boys developed an incarcerated hernia and seven (17%) developed recurrent inguinal hernias. All recurrences occurred in boys under 2 years of age, were associated with an indirect sac and were unrelated to the seniority of the surgeon performing the initial herniotomy. No recurrences occurred in eight boys undergoing inguinal herniotomy at the time of bladder closure. CONCLUSIONS: Boys with classical bladder exstrophy managed by staged reconstruction have a much higher incidence of inguinal hernias than previously recognized. Most are bilateral, present in early infancy and are prone to incarceration. Bilateral groin exploration and meticulous inguinal herniotomy at the time of bladder closure may reduce morbidity.