Prevention Technique of Postoperative Inguinal Hernia in Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer

Abstract

To prevent inguinal hernia after retropubic radical prostatectomy, many urologists have utilized a prevention technique of inguinal hernia at the same time as retropubic radical prostatectomy. Here, we report the clinical benefit of the prevention technique of inguinal hernia as well as risk factors for the incidence of inguinal hernia. We investigated the medical records of 223 men who underwent retropubic radical prostatectomy for clinically localized prostate cancer between January 2007 and March 2013 at our medical center. We assessed the association between the postoperative inguinal hernia and variables such as age, body mass index, and previous abdominal surgery. Inguinal hernia-free survival was analyzed to verify risk factors of postoperative inguinal hernia. Of 223 patients, 67 (30 %) received prevention of inguinal hernia and 156 (70 %) did not. The median follow-up period after retropubic radical prostatectomy was 36 months (range, 3-58 months). Thirty one (14 %) patients developed unilateral or bilateral inguinal hernia after retropubic radical prostatectomy. The rate of postoperative inguinal hernia in prevented and non-prevented group was 3 % (2 of 67) and 19 % (29 of 156), respectively (P < 0.01, Mann-Whitney U test). Moreover, postoperative inguinal hernia-free survival in the prevention group was significantly longer than that in the nonprevented group (P < 0.01, log-rank test). In the prevention group, 1-, 2-, and 3-year inguinal hernia-free survival rates were 100 %, 96 %, and 96 %, respectively. Other clinical factors including age, body mass index, previous abdominal surgery, and previous inguinal hernia were not associated with the incidence of inguinal hernia in our cohort. The prevention technique was simple and safe to perform, and it could increase inguinal hernia-free survival rates after retropubic radical prostatectomy.

Incidence and risk factors of inguinal hernia occurred after radical prostatectomy-comparisons of different approaches

“…The best way to prevent PIH after prostatectomy remains debatable. Hori et al bluntly detached peritoneum at the internal ring so as to isolate spermatic cord, merely 3% of RRP patients in prevented group developed PIH compared to 19% in non-prevented group [ 27 ]. Another effective procedure, opening the spermatic sheath and releasing approximately 5 cm bilateral vas deferens and spermatic vessels from the peritoneum, resulted in 0.87% PIH rate in prevented group while 15.7% non-prevented patients suffered from PIH, was introduced by Koike in 2013 [ 28 ].…”

Incidence of Inguinal Hernia after Radical Prostatectomy: A Systematic Review and Meta-Analysis

“…Prevention Techniques. We found 12 studies investigating 2 inguinal hernia prevention techniques, including the spermatic cord isolation method 23,24,26,43,60,62,63 and the processus vaginalis transection method. 25,26,36,58,59,61 The spermatic cord isolation method focused on the internal inguinal ring area with blunt dissection of the peritoneum and subsequent isolation of the spermatic cord from the surrounding peritoneum at the internal inguinal ring via a preperitoneal approach.…”

Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

“…As for the difference in hernia incidence, Shimbo et al ( 36 ) noted that urethrovesical anastomosis during c-RARP surgery might lead to overstretching of the peritoneum and vas deferens, resulting in medial displacement and enlargement of the inner ring, leading to increased hernia incidence. Compared with c-RARP, RS-RARP can maximize the protection of the anterior compartment and myopectineal orifice to prevent the displacement of the internal ring, thus greatly reducing the incidence of hernia ( 17 , 37 ). Although RS-RARP is theoretically less invasive than c-RARP, there is no significant difference in estimated blood loss.…”