Lower Incidence of Inguinal Hernia: Minilaparotomy Radical Retropubic Prostatectomy Compared with Conventional Technique

Abstract

Introduction: The purpose of the present study was to compare the incidence of inguinal hernias after conventional and minilaparotomy (minilap) radical retropubic prostatectomy (RRP). Patients and Methods: In this retrospective study, we review our experience with 70 consecutive patients with prostate cancer who underwent prostatectomy from April 1995 through March 2001. Of these, 35 patients had conventional RRP, and 35 patients had minilap RRP. Results: Conventional RRP and minilap RRP groups were similar in body mass index (mean 24.4 and 23.5), operative time (mean 260 and 241 min), previous lower abdominal operation record (mean 37.1 and 25.7%), and post-prostatectomy anastomotic strictures (mean 11.4 and 14.3%). The volume of the estimated blood loss was significantly less for minilap RRP (mean 1,220 ml) than for conventional RRP (mean 1,666 ml; p = 0.0194). The incidence of postoperative inguinal hernias was 17.1% (6 of 35), 2.9% (1 of 35), and 3.2% (1 of 31) in conventional RRP, minilap RRP, and unoperated groups, respectively. The incidence of inguinal hernias after minilap RRP was significantly lower than after conventional RRP (p = 0.0464). Seven patients with postoperative inguinal hernias had a high incidence of postoperative strictures (42.9%), while 63 patients without hernia had a low incidence (9.5%). There was a significant difference in developing postoperative strictures between patients with hernia and those without (p = 0.0124). While postoperative stricture and operative technique were different in the hernia and hernia-free groups on univariate analysis, multivariate logistic analysis revealed that the operative technique was an independent factor for the occurrence of inguinal hernias (p = 0.0419). Conclusion: Minilap RRP compares favorably with conventional RRP in view of the postoperative inguinal hernia development.

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

“…16 Nomura et al experienced post-operative inguinal hernia in 6 of 35 (17.1%) patients in the conventional RRP group and in only 1 of 35 (2.9%) in the mini-laparotomy RRP group. 19 Our results, 19.2% (41 of 224) in the conventional RRP and 5.9% (7/119) in the MIES-RRP groups, were compatible with these previous observations. The high hernia-free survival rate in MIES-RRP could be attributable to less damage to the abdominal wall structures, exemplified by a shorter abdominal midline incision (5-8 cm) and thus less damage to the transversalis 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.…”

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

“…Comparing the postoperative incidence among ORP, PLND, cystectomy, and no surgery, IH incidence was shown to be highest after ORP, followed by retroperitoneal PLND, transperitoneal cystectomy, and no surgical treatment [2,7] . Nomura et al [24] showed IH incidence decreased from 17.1% after conventional RRP to 2.9% after minilaparotomy radical prostatectomy in a small pilot study, hypothesizing based on cadaveric studies, that damage to the posterior layer of the rectus sheath disrupted the linkage between Hesselbach's ligament and falx inguinalis, weakening the IIR. We suggest a possible mechanism for IH occurrence after RARP.…”

Nerve-sparing procedure in radical prostatectomy: A risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures

“…The reported incidence of inguinal hernia following radical prostatectomy ranges between 2.9 and 38.7% (Table IV) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Recent analysis of data from a Quebec Health Plan database demonstrated that the 1, 2, 5 and 10-year inguinal hernia repair rates following radical prostatectomy were 4.4%, 6.7%, 11.7% and 17.1%, respectively [17].…”

“…Several risk factors have been reported including a history of inguinal hernia repair [2,4,6,9,11], a history of major abdominal surgery [15], preoperative subclinical inguinal hernia [8,10,16,22], advanced age [2,9,10], lower body mass index [4,10,11,13], postoperative anastomotic stricture [2,9], wound infection [6], a long lower abdominal incision [7,14,15] and type of surgical procedure [2,4,5]. However, no specific aspect of surgery has been implicated (Table III).…”