Risk factors and prevention of inguinal hernia after radical prostatectomy: a systematic review and meta-analysis

Inguinal hernia is widely recognized as a complication after radical prostatectomy. We systematically investigated the risk factors for inguinal hernia, compared the incidence after various surgical procedures and explored prophylactic surgical maneuvers.

A systematic search of the literature was performed using Medline®, Web of Knowledge® and the Cochrane Library databases. All analyses and tests were conducted using STATA® software.

A total of 31 trials from 29 eligible studies were identified according to the predefined selection criteria. As integrated, postoperative inguinal hernia developed in 15.9% (13.1-18.7) of patients who underwent radical retropubic prostatectomy and 6.7% (4.8-8.6) of those who underwent laparoscopic radical prostatectomy. Most cases of inguinal hernia occurred within the first 2 years after surgery. Right side and indirect-type dominance was found in those inguinal hernias. Pooled results of comparative studies revealed that the incidence of inguinal hernia after radical retropubic prostatectomy was significantly higher than that after no operation, laparoscopic surgery, radical perineal prostatectomy, mini-laparotomy radical retropubic prostatectomy and pelvic lymph node dissection, but was not significantly higher than that after open prostatectomy and cystectomy. In addition, increasing age, low body mass index, subclinical inguinal hernia, previous inguinal hernia repair and anastomotic stricture can increase the risk for inguinal hernia after radical prostatectomy.

While some limitations cannot be overcome, this meta-analysis suggests that damage to the posterior layer of the rectus sheath may be involved in the development of inguinal hernia after radical prostatectomy. Prophylactic surgery for high risk subjects is advised at the time of radical prostatectomy to minimize the incidence of inguinal hernia.