Outcomes after concurrent inguinal hernia repair and robotic-assisted radical prostatectomy

Abstract

Inguinal hernias occur more frequently following radical prostatectomy. Simultaneous inguinal hernia repair during open and laparoscopic radical prostatectomy for prostate cancer has been described previously. The emergence of robotic-assisted radical prostatectomy (RALP) has necessitated the evaluation of concomitant herniorrhaphy in this new setting. We report the outcomes of this operation in our series of patients. Retrospective review was performed on 700 patients with localised prostate cancer who underwent RALP performed by a single surgeon from 2004 to 2009. Details of cases where concurrent inguinal hernia repair was performed were recorded and compared with the remainder of the cohort. Hernia repair was performed using a monofilament knitted polypropylene cone mesh plug and fascial defect closure with Hem-o-Lok clips. A total of 38 inguinal herniorraphies were performed in 37 patients as a simultaneous procedure during transperitoneal RALP. The hernia repair on average added 5-10 min to the total procedure time. One patient underwent a bilateral repair. Across this group, mean age was 62.9 years, average body mass index was 27.1, and median follow-up was 29 months. There were no complications at the time of mesh placement. There were no cases complicated by wound infection, fluid collection, or chronic pain. Recurrence of an inguinal hernia occurred in one patient due to migration of the mesh. We conclude that concomitant inguinal hernia repair during RALP is safe, feasible, and effective. The herniorrhaphy can be performed quickly, adds little to the overall procedure time and avoids a further operative procedure for the patient.

Keywords: Inguinal hernia; Laparoscopy; Prostatectomy; Robotics.