Simultaneous Inguinal Hernia Repair with Monofilament Polypropylene Mesh during Robot-Assisted Radical Prostatectomy: Results from a Single Institute Series

Abstract

Background and Objectives: Inguinal hernia (IH) is a usual finding in men with prostate cancer (PCa) due to their similar risk factors, such as age, gender, and smoking. This study aims to present a single institution’s experience with simultaneous IH repair (IHR) and robotic-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively reviewed 452 patients who underwent RARP between January 2018 and December 2020. A total of 73 patients had a concomitant IHR with a monofilament polypropylene mesh. Patients with bowel in the hernia sac or recurrent hernia were excluded. Results: The median age and the American Society of Anesthesiologists (ASA) score were 67 years (inter-quartile range (IQR) 56–77) and 2 (IQR 1–3), respectively. The median prostate volume and preoperative prostate-specific antigen (PSA) were 38 mL (IQR 25.0–75.2) and 7.8 ng/mL (IQR 2.6–23.0), respectively. The surgery was successfully performed in all cases. The median overall and IHR operative time were 190.0 (IQR 140.0–230.0) and 32.5 (IQR 14.0–40.0) minutes, respectively. The median estimated blood loss and length of hospital stay were 100 mL (IQR 10–170) and 3 days (IQR 2–4), respectively. Only five (6.8%) minor complications occurred after surgery. At the 24-month follow-up, no cases of mesh infection, seroma formation, or groin pain were recorded. Conclusions: This study confirmed the safety and efficacy of performing simultaneous RARP and IHR.

Previous inguinal hernia surgery does not limit the likelihood of choosing prostatectomy as primary prostate cancer therapy

“…Recently studies have been published about feasibility of simultaneous RALP and LIHR. Naturally this would not aid those subjects that have had the LIHR operation done previously 12 , 13 .…”

“…More recent studies have reported that RALP can be performed safely and with good oncological results after LIHR 9 – 11 . Recently published articles has described feasibility of simultaneous RALP and LIHR operations 12 , 13 .…”

A case of enormous retroperitoneal liposarcoma with prolapse from the left inguinal canal following hernia repair

“…Among the 15 cases listed in Table 2 , inguinal repair was performed in 8 cases, with mesh being used for repair in only 2 cases, including our case. Although International guidelines for groin hernia management [ 19 ] do not specifically address simultaneous surgery for malignant tumors and inguinal hernia repair using mesh, the safety of simultaneous surgery for malignant tumors, such as prostate cancer, and inguinal hernia repair with mesh has been reported in multiple studies [ 20 – 22 ]. In the two cases that experienced recurrence in our study, inguinal repair was performed, but mesh was not used, and tumor residue was considered the cause of recurrence.…”