Laparoscopic inguinal hernia repair after prostatectomy: Evaluating safety, efficacy, and efficiency

Area of Science:

• Surgical innovation
• Hernia repair techniques
• Urologic surgery outcomes

Background:

• Prior prostatectomy is often considered a contraindication for laparoscopic totally extraperitoneal (TEP) hernia repair.
• This perception may limit treatment options for patients with a history of prostate surgery.

Purpose of the Study:

• To evaluate the safety, efficacy, and efficiency of TEP hernia repair in patients with a prior prostatectomy.
• To compare TEP outcomes in this cohort with matched controls and patients undergoing open hernia repair.

Main Methods:

• A prospectively collected hernia database was reviewed for TEP repairs performed between October 2009 and March 2018.
• Patients with prior prostatectomy were matched to controls without prior prostatectomy.
• Secondary analysis compared TEP repair to open hernia repair in the prostatectomy group.

Main Results:

• Laparoscopic TEP repair in 30 patients with prior prostatectomy showed longer operative times and more peritoneal tears compared to 90 controls.
• However, length of stay, return to activity, complications, recurrence, and chronic pain rates were equivalent between groups.
• Compared to open repair, TEP in prior prostatectomy patients had similar outcomes but faster return to daily activities (3 vs. 7 days).

Conclusions:

• Laparoscopic TEP hernia repair is a safe, efficacious, and efficient option for patients with a prior prostatectomy, despite a more challenging dissection.
• TEP offers comparable outcomes to open repair with the added benefit of a quicker recovery period in this specific patient population.