Combined Inguinal Hernia Repair With Prosthetic Mesh During Transperitoneal Robot Assisted Laparoscopic Radical Prostatectomy: A 4-Year Experience

Purpose

Inguinal hernias are detected in 20% to 30% of patients undergoing radical prostatectomy. We report our experience with concomitant transperitoneal robot assisted laparoscopic radical prostatectomy and intraperitoneal inguinal herniorrhaphy using prosthetic mesh.

Materials and Methods

A retrospective review was performed of the medical records of 533 consecutive robot assisted laparoscopic radical prostatectomies performed by 1 surgeon from June 2002 to April 2007. All cases that included combined herniorrhaphy were recorded in a prospective database, reviewed and compared against a cohort of patients matched for body mass index and age who underwent robot assisted laparoscopic radical prostatectomy alone.

Results

A total of 49 concurrent herniorrhaphy procedures were performed in 40 patients for 31 unilateral (left side in 30 and right side in 19) and 9 bilateral inguinal hernias. Five patients underwent prior ipsilateral inguinal herniorrhaphy, and 3 each underwent contralateral and prior bilateral repair. Preoperatively 15 of 40 patients (37.5%) had a definite inguinal hernia, 5 (12.5%) had noticeable weakness of the external ring and 20 (50%) had a completely normal physical examination. Compared with a matched cohort undergoing robot assisted laparoscopic radical prostatectomy alone there were no significant differences in smoking history, narcotic use, hospital stay or complications. Hernia repair added approximately 10 minutes of operative time. Postoperatively 1 of 49 hernias (2.0%) recurred at 4 months during a median followup of 15.3 months. There were no complications related to hernia repair.

Conclusions

Concurrent repair of inguinal hernias during transperitoneal robot assisted laparoscopic radical prostatectomy using prosthetic mesh is technically feasible and effective, and without increased complications or morbidity.

Key Words: prostate, hernia, robotics, laparoscopy, prostatectomy

Abbreviations and Acronyms: BMI, body mass index, CT, computerized tomography, MS, morphine sulfate equivalents, RALP, robot assisted laparoscopic radical prostatectomy