The impact of previous laparoscopic inguinal hernia repair on radical prostatectomy

Laparoscopic inguinal hernia repair has become a frequently performed procedure. It is thus inevitable that some candidates for radical prostatectomy for prostatic carcinoma will have undergone such previous intervention. Mesh placement in the space of Retzius as performed in laparoscopic hernia repair may cause obliteration of the preperitoneal space, complicating radical prostatectomy. The objective of this review was to assess the literature regarding outcomes of radical prostatectomy (open, laparoscopic, robot-assisted) after laparoscopic inguinal hernia repair with mesh placement and to investigate whether key outcomes are compromised.

A literature search was conducted in the PUBMED database using the search terms "prostatectomy" and either "hernia repair" or "herniorrhaphy." A further evaluation of the references cited in the articles that were found was performed. Only publications related to radical prostatectomy after laparoscopic hernia repair were included.

A total of 15 articles referring to radical prostatectomy after laparoscopic hernia repair were found. These publications included a total of 436 patients. We evaluated operative and long-term outcome parameters such as completion of radical prostatectomy, completion of lymph node dissection, operative complications, and long-term, functional, and oncologic outcome.

Radical prostatectomy (open, laparoscopic, robot-assisted) is feasible and safe after laparoscopic inguinal hernia repair. The procedure is technically demanding, although perioperative, oncologic, and functional outcomes do not differ from those after radical prostatectomy without previous laparoscopic inguinal hernia repair. Pelvic lymph node dissection may not be safe in some patients and may compromise accurate staging. A potential future need for radical prostactectomy in a male patient with inguinal hernia should not be a determining factor against a laparoscopic approach to inguinal hernia repair.