Impact of concomitant hernia repair at the time of complete primary repair of bladder exstrophy.
BACKGROUND
Inguinal hernias are common in the bladder exstrophy population. As these hernias may present with incarceration following bladder closure, several groups recommend inguinal exploration and hernia repair at the time of initial bladder closure. However, the benefits of such an approach are not well defined. In 2006, we modified our approach to this condition by routinely performing concomitant inguinal herniorraphy (CIH) repair at the time of initial exstrophy repair. The aim of this study was to test the hypothesis that simultaneous inguinal hernia repair will be safe and effective in reducing subsequent unplanned inguinal procedures in this high-risk group.


METHODS
We conducted a retrospective chart review of patients with classic bladder exstrophy managed with complete primary repair (CPRE) from 1990 to 2014, with focus on inguinal hernia repair at the time of bladder closure and subsequent need for inguinal surgery. We excluded patients with follow-up less than 6 months, missing data with regards to the initial inguinal approach at the time of bladder closure, and patients with intra-abdominal testicles.


RESULTS
A total of 43 patients were included for analysis with 27 (61%) having inguinal hernias identified either at birth or in subsequent follow-up, including 20 of 27 boys and 7 of 16 girls. A summary of comparison groups with and without CIH at the time of CPRE, as well as follow-up and need for subsequent hernia repair, is given in the summary Table. Of 25 patients without concomitant inguinal herniorraphy at CPRE, 10 patients required subsequent inguinal surgeries for inguinal herniorraphy (seven), orchiopexy (one), or inguinal herniorraphy plus orchiopexy (two).


CONCLUSIONS
CIH at the time of CPRE is safe, with no significant inguinal complications noted. Subsequent inguinal operations were more often required in the cohort of patients not receiving CIH at the time of CPRE, including one patient presenting with incarceration. Thus, CIH appears to reduce need for subsequent inguinal operations when performed at the time of bladder closure. Our study adds to other authors' claims that CIH should be attempted at the time of bladder closure. This study is limited by the retrospective nature of the review and differences in follow-up times between groups. Simultaneous inguinal hernia repair at the time of initial exstrophy repair is safe and associated with decreased incidence of subsequent inguinal surgery. Such an approach should be undertaken during initial bladder closure.
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA. Electronic address: jonathan.ellison@seattlechildrens.org.
Jonathan S
JS
Ellison
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA.
Margarett
M
Shnorhavorian
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA.
Paul A
PA
Merguerian
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA.
Richard
R
Grady
D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000379:methods
Bladder exstrophy; Complete primary repair of exstrophy; Inguinal hernia