Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Abstract

Introduction: To evaluate the incidence and risk factors for postoperative inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) and to assess whether a newly developed prevention technique reduces the incidence of IH after RARP. Methods: We included 161 consecutive patients (322 groins) who underwent RARP between September 2011 and October 2013. The prevention technique was as follows: (1) sufficient incision of peritoneum around the internal inguinal ring; (2) separation of spermatic vessels; (3) dissection of vas deferens. Results: Postoperative IH occurred in 14 cases (19.4%) occurring in the observation group compared to 2 cases (2.2%) in the prevention group. Patent processus vaginalis (PPV) was the only risk factor. Time-to-event analysis demonstrated a significant decrease in IH incidence in the IH prevention group (p = 0.005). Conclusion: Our data reveal a higher incidence of IH after RARP, with the existence of PPV as the only identified risk factor. Our simple IH-prevention technique, which does not involve the use of artificial materials, appears safe and effective.

Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

“…12 A PPV visualized at the time of MIRP was another significant risk factor for IH development. 7,14,19 An IH developed after RARP in 18% vs 6.4% of men with vs without a PPV. 7 Lee et al observed similar results in which a post-RARP IH developed in 26.5% of men with a PPV compared to 1.9% with no PPV.…”

“…7,14,19 An IH developed after RARP in 18% vs 6.4% of men with vs without a PPV. 7 Lee et al observed similar results in which a post-RARP IH developed in 26.5% of men with a PPV compared to 1.9% with no PPV. 14 Further, the PPV reduced the inguinal hernia-free ratio time to IH development compared to that in men with no PPV (mean AE SD 12.9 AE 9.2 vs 15 AE 7.4 months).…”

“…Of these hernias 90% were indirect inguinal hernias and they were more commonly on the right side. 7,8 Most included studies were retrospective and relied on institutional databases and medical records for data accrual. Only a single study was prospective.…”

Inseparable interaction of the prostate and inguinal hernia

“…Shimbo et al . postulated that the peritoneum and vas deferens were stretched during urethrovesical anastomosis, resulting in a medial shifting of the internal ring, with subsequent widening leading to IH development . Moreover, Lee et al .…”

“…Shimbo et al postulated that the peritoneum and vas deferens were stretched during urethrovesical anastomosis, resulting in a medial shifting of the internal ring, with subsequent widening leading to IH development. 25 Moreover, Lee et al reported that a patent processus vaginalis, which is a peritoneal protrusion toward the deep inguinal ring, is an important risk factor for IH after RARP. 26 As discussed above, Kaiho et al proposed that repeated straining for urination pushes the small intestine into the funnel-shaped processus vaginalis, which can easily occur following release of the vas deferens from the prostate during RP.…”