Herniotomy at the Primary Repair of Bladder Exstrophy Revisited

To evaluate inguinal hernia incidence, recurrence, and outcomes in male bladder exstrophy (BE) patients managed within the paradigm of bladder closure and Kelly repair. This study compares findings with data from alternative surgical strategies, including the complete primary repair of exstrophy (CPRE) approach.

A retrospective review of 154 male BE patients treated between 1995 and 2023 was conducted. Patients were divided into 2 groups: those who underwent prophylactic herniotomy at the time of bladder closure (n = 67) and those who did not (n = 87). Data on hernia emergence, recurrence, timing of presentation, and incarcerations were collected and compared with published data.

In the prophylactically repaired group, hernia recurrence occurred in 15.1% of patients, with a median time of 12.6 months. In the non-prophylactically repaired group, hernias developed in 34.5% of patients, with a median time to presentation of 3.2 months. No incarcerations were observed in the prophylactically repaired group, while 6 incarcerations (20% incidence) occurred in the non-prophylactic group.

Prophylactic herniotomy at male infant bladder closure reduces hernia emergence and recurrence compared to delayed repair strategies. Differences in hernia presentation and recurrence rates between staged approaches and CPRE highlight the potential impact of surgical timing, absence of osteotomy, and procedural variability. Prophylactic herniotomy during infant bladder closure remains a protective intervention in staged repair approaches. Further study is warranted to better understand variations in hernia presentation across operative strategies.