Preperitoneal repair of inguinal hernia
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Published on: September 11, 2021
Marco Castagnetti1, Waifro Rigamonti
1Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy. marcocastagnetti@hotmail.com
Insights
This study presents a pre-emptive inguinal hernia treatment for boys with bladder exstrophy. The innovative approach showed no recurrence in patients, offering a promising solution for this high-risk group.
Area of Science:
- Pediatric Surgery
- Urology
- Congenital Abnormalities
Background:
- Bladder exstrophy is associated with a high risk of inguinal hernia recurrence.
- Standard inguinal hernia repair can be challenging in patients with bladder exstrophy due to pelvic anatomy.
Purpose of the Study:
- To evaluate the efficacy of a pre-emptive inguinal hernia treatment in boys with bladder exstrophy.
- To assess the recurrence rate of inguinal hernias in this patient population.
Main Methods:
- A cohort of five boys with bladder exstrophy underwent a pre-emptive inguinal hernia repair.
- The procedure involved avoiding direct manipulation of the inguinal canal.
- Follow-up was conducted for a median of 29 months.
Main Results:
- No inguinal hernia recurrence was observed in any of the treated patients.
- The median follow-up period was 29 months (range: 5–46 months).
- Pelvic diastasis in these patients facilitated easier cord dissection.
Conclusions:
- Pre-emptive inguinal hernia treatment in boys with bladder exstrophy is effective in preventing recurrence.
- This approach may be advantageous due to altered pelvic anatomy and avoidance of inguinal canal manipulation.
- The technique could potentially be adapted for other pediatric surgical procedures involving the perivesical space.
Abstract:
From 2007 to date, fi ve boys with bladder exstrophy underwent this pre-emptive treatment of inguinal hernia at our institution. None has developed a recurrence after a median (range) follow-up of 29 (5 – 46) months. This approach avoids any manipulation of the inguinal canal, which is an advantage per se, but may be even more important in children with bladder exstrophy given the relatively high risk of hernia recurrence reported [ 1,2 ] . Furthermore, the presence of a pelvic diastasis makes the pelvic dissection of the cord easier than in normal children with a closed pelvic ring. The same procedure can also possibly be performed in children with a congenital inguinal hernia undergoing other procedures that require dissection of the perivesical space, e.g. ureteric re-implantation or ureterocoele repair.
