Risk of hernia formation after radical prostatectomy: a comparison between open and robot-assisted laparoscopic radical prostatectomy within the prospectively controlled LAPPRO trial

Abstract

Purpose In addition to incisional hernia, inguinal hernia is a recognized complication to radical retropubic prostatectomy. To compare the risk of developing inguinal and incisional hernias after open radical prostatectomy compared to robot-assisted laparoscopic prostatectomy. Method Patients planned for prostatectomy were enrolled in the prospective, controlled LAPPRO trial between September 2008 and November 2011 at 14 hospitals in Sweden. Information regarding patient characteristics, operative techniques and occurrence of postoperative inguinal and incisional hernia were retrieved using six clinical record forms and four validated questionnaires. Results 3447 patients operated with radical prostatectomy were analyzed. Within 24 months, 262 patients developed an inguinal hernia, 189 (7.3%) after robot-assisted laparoscopic prostatectomy and 73 (8.4%) after open radical prostatectomy. The relative risk of having an inguinal hernia after robot-assisted laparoscopic prostatectomy was 18% lower compared to open radical retropubic prostatectomy, a non-significant difference. Risk factors for developing an inguinal hernia after prostatectomy were increased age, low BMI and previous hernia repair. The incidence of incisional hernia was low regardless of surgical technique. Limitations are the non-randomised setting.Conclusions We found no difference in incidence of inguinal hernia after open retropubic and robot-assisted laparoscopic radical prostatectomy. The low incidence of incisional hernia after both procedures did not allow for statistical analysis. Risk factors for developing an inguinal hernia after prostatectomy were increased age and BMI.

Utility of Robot-assisted Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia Following Robot-assisted Laparoscopic Radical Prostatectomy

“…However, RP, including RALP, sometimes leads to PIH, which is painful and affects the patient's quality of life. The reported incidence rate of PIH was 3.4-7.3% after RALP and 8.4% after open RP (15,16). PIH usually occurs within the first 3 years after RP (17).…”

The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan

“…Minimally invasive surgery is performed in a variety of areas. The incidence of incisional hernia is reported to be 0.2%–4.8% after RARP 4,10 and 0.9%–25.7% after laparoscopic colorectal surgery 2,3 . During the watchful waiting period for incisional hernias, 19%–33% of patients end up undergoing surgery, with an emergency operation rate of 4%–7.7% 11,12 .…”

“…An incisional hernia is one of the complications after abdominal surgery, with a reported incidence of 11%–20% 1 . Although minimally invasive surgery is widely used in various surgical areas, incisional hernia remains a frequent complication, ranging from 0.9% to 25.7% 2–4 . Laparoscopic incisional hernia repair with intraperitoneal onlay mesh (IPOM) is widely performed because of the simplicity of its technique and a low postoperative surgical site infection rate.…”

“…1 Although minimally invasive surgery is widely used in various surgical areas, incisional hernia remains a frequent complication, ranging from 0.9% to 25.7%. [2][3][4] Laparoscopic incisional hernia repair with intraperitoneal onlay mesh (IPOM) is widely performed because of the simplicity of its technique and a low postoperative surgical site infection rate. However, laparoscopic IPOM can come with non-negligible mesh-related complications such as mesh bulge, seroma, hematoma, chronic pain, intestinal fistula, mesh infection, and adhesive bowel obstruction.…”

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

“…Inguinal hernias have been demonstrated to be increased after anterior radical prostatectomy, both in robotic and open surgeries [49]. RS-RARP, going only through a posterior incision and avoiding peritoneal and bladder mobilization, has been reported to reduce the rate of postoperative inguinal hernias, both in single-center studies [51,52,53 ▪▪ ] and in systematic reviews [32].…”