INGUINAL-HERNIAS ASSOCIATED WITH BLADDER EXSTROPHY

Objective To determine the incidence and complications of inguinal her nias in patients with bladder exstrophy. Patients and methods A retros pective review of inguinal hernias and their management in 70 consecut ive 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 we re bilateral in 35 (78%) cases. All but three of these patients presen ted during infancy. In girls, no instance of incarceration or recurren ce was noted. In contrast, 14 (29%) boys developed an incarcerated her nia and seven (17%) developed recurrent inguinal hernias. All recurren ces occurred in boys under 2 years of age, were associated with an ind irect sac and were unrelated to the seniority of the surgeon performin g the initial herniotomy. No recurrences occurred in eight boys underg oing inguinal herniotomy at the time of bladder closure. Conclusions B oys with classical bladder exstrophy managed by staged reconstruction have a much higher incidence of inguinal hernias than previously recog nized. Most are bilateral, present in early infancy and are prone to i ncarceration. Bilateral groin exploration and meticulous inguinal hern iotomy at the time of bladder closure may reduce morbidity.