Impact of laparoscopic inguinal hernia repair mesh on open radical retropubic prostatectomy

Open radical retropubic prostatectomies (RRP) have been abandoned after previous laparoscopic inguinal hernia repair (LIHR) with mesh, which can be a relative contraindication to open RRP. Radiation therapy and radical perineal prostatectomy are alternative treatment options for prostate cancer when faced with this dilemma. Our objective is to report our experience with open RRP after LIHR.

A retrospective chart review was conducted from January 2000 to December 2007 of all open RRP executed by a single surgeon (F.F.M.) with prior LIHR. All information on LIHR, including laterality and its effect on pelvic lymphadenectomy (LAD), were analyzed. Pre-, intra-, and postoperative data were recorded.

Of the 949 men who underwent RRP performed by this surgeon, a cohort of 21 men had prior LIHR (a total of 29 IHR: 13 unilateral and 8 bilateral). The mean age and PSA were 61.0 years and 5.8 ng/mL, respectively. Of the men, 18 and 3 men presented with T1c and T2a clinical stage, respectively. Preoperatively 18 men, 2 men, and 1 man had a Gleason score of 6, 3+4, and 8, respectively. All RRP subsequent to LIHR were successful with minimal complications. A total of 4, 4, 11, and 2 men had stage pT2a, pT2b, pT2c, and pT3a, respectively. Fifteen men (71%) had either unilateral (4 men) or bilateral (11) LAD (all pN0), whereas 6 men had no LAD because of severe pelvic scaring.

Our experience demonstrates that open RRP after LIHR with mesh can typically be performed with minimal risks and in carefully selected patients for best outcomes, but LAD might be compromised.