Laparoscopic Inguinal Herniotomy In Bladder Exstrophy: A New Solution To An Old Problem?
April 12, 2007 – 2:59 pm | posted in Urology / NephrologyUroToday.com- A study from the Great Ormond Street Hospital evaluated laparoscopy as an option for inguinal herniotomy in patients with bladder exstrophy. Inguinal hernias are a well established problem in patients with bladder exstrophy. The rate of inguinal hernia recurrence in patients with bladder exstrophy who had undergone inguinal herniotomy in the past can be a high as 15%. The group reported their initial experience with a laparoscopic repair of inguinal hernia in 3 children with bladder exstrophy.
These 3 boys that underwent bladder exstrophy repair presented with an inguinal hernia during follow-up. The clinical presentation was bilateral in 1 patient and the findings at surgery were bilateral open internal rings in 2 patients. The inguinal herniotomy was performed with one Trocar in the umbilicus and 2 stab incisions for instrumentation. They utilized a 4/0 Prolene purse string suture to securely close the internal ring.
The group found that all the infants made and uneventful recovery and discharge within 24 hours. There were no complications. There has been no sign of recurrence during the mean follow-up of 16 months in their 3 patients. They state that laparoscopic inguinal herniotomy in this population is technically straight forward and may be an effective way to treat these inguinal hernias in children with bladder exstrophy that may otherwise recur during and open repair. In my experience, laparoscopic herniorrhaphies done during laparoscopic orchiopexies are very straight forward and easy to perform. It may be actually be one of the best ways to teach our residents and fellows proper laparoscopic techniques. Performed with a 3 mm scope and 3 mm instrumentation, this can be done with extreme safety on an outpatient basis. The procedure incorporates not only laparoscopic access but also intracorporeal suturing techniques which is the most difficult aspect of laparoscopy for our mentees to master.
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