Incidence of inguinal hernia after prostate surgery: Open radical retropubic prostatectomy versus open simple prostatectomy versus transurethral resection of the prostate

Abstract

Abstract:Our objective was to determine the incidence of inguinal hernia (IH) after surgery for prostatic diseases. Medical records of 395 patients who underwent radical retropubic prostatectomy (RRP; n = 155), open simple prostatectomy (OP; n = 35), or transurethral resection of the prostate (TURP; n = 205) at the Chibaken Saiseikai Narashino Hospital from April 2000 to March 2007 were retrospectively evaluated. The incidence of IH was 23.9% in the RRP group, 18.9% in the OP group, and 2% in the TURP group. Overall, 91.9% in the RRP and 83.3% in the OP group developed an IH within 2 years postoperatively. The laterality of IH after open surgery was mainly on the right side. Subclinical IH were seen in 25% of RRP cases. The existence of subclinical IH was the only significant risk factor for postoperative IH in this analysis. Furthermore, OP and RRP procedures significantly increased the risk of postoperative IH compared with TURP. The hernia-free ratios were significantly lower after RRP and OP than after TURP (vs RRP: P < 0.001; vs OP: P < 0.001). Our findings confirm that a lower abdominal incision itself is associated with postoperative IH in patients undergoing prostate surgery. Attention must be paid to pre-existing subclinical IH through careful preoperative assessment. Patients should be followed for more than 2 years due to the high incidence of postoperative IH.

Optimizing the detection of subclinical inguinal hernias in men undergoing open radical retropubic prostatectomy

“…One study reported a significant relationship between postoperative wound-related problems and the development of IH after RRP [16]. No study has ever shown evidence linking prostate volume [3,4,16], duration of surgery [17] or smoking history [16] to the development of IH after RP.…”

“…Inguinal hernias (IHs) develop in 8.6-23.9% of men undergoing open radical retropubic prostatectomy (ORRP) [1][2][3][4][5]. This high rate of IHs after ORRP led to the conclusion that the surgical procedure was the direct cause of these IHs.…”

Lower incidence of inguinal hernia after radical prostatectomy using open gasless endoscopic single-site surgery

“…The incidence of inguinal hernia is as high as after simple open prostatectomy for BPH that is not accompanied by resection of endopelvic fascia. 7 The incidence was not significantly reduced by the modified RRP, in which both vasa deferentia and surrounding tissues were dissected before placing the retractor so as not to retract them and injure the myopectineal orifice. 8 Most ideas about the altered anatomical structure of fascia or muscle have been controversial to date, and it seems to be difficult to attribute a single cause to inguinal hernia.…”

“…Age 5,6,9,[15][16][17][18]20 and anastomic stricture 9,14,17,18,20,21 have been suggested as risk factors in some studies, but not in others. Resection of endopelvic fascia 7 and retraction of the vasa deferentia by a retractor 8 are probably not the causative factors. The incidence of inguinal hernia is as high as after simple open prostatectomy for BPH that is not accompanied by resection of endopelvic fascia.…”

“…There are a number of potential causative risk factors that have been hypothesized and tested. Previous abdominal surgery, 6,16 sub-clinical inguinal hernia 7,17,18 and the length of incision 16,19 are supposed to be related to post-operative inguinal hernia. Age 5,6,9,[15][16][17][18]20 and anastomic stricture 9,14,17,18,20,21 have been suggested as risk factors in some studies, but not in others.…”