Totally extraperitoneal laparoscopic inguinal hernia repair post-radical prostatectomy

Area of Science:

• Urology
• General Surgery
• Minimally Invasive Surgery

Background:

• Previous radical prostatectomy (RP) is often considered a contraindication for laparoscopic inguinal hernia repair (LIHR).
• The safety and efficacy of totally extraperitoneal (TEP) LIHR following RP require further investigation.

Purpose of the Study:

• To compare the feasibility, safety, and outcomes of TEP LIHR in patients who have undergone prior RP versus those who have not.
• To analyze operative and post-operative outcomes based on the type of prior RP (open, laparoscopic, or robotic).

Main Methods:

• A single-surgeon, case-control study utilizing a prospective database from 1995-2020.
• Patients undergoing TEP LIHR with prior RP were matched with controls without prior RP.
• Pre-operative, operative, and post-operative data were analyzed, including hernia recurrence and chronic pain at 3-month follow-up.

Main Results:

• 165 patients with prior RP were compared to 6367 primary LIHR controls.
• TEP LIHR in patients with prior RP had longer operative times but no significant differences in complication rates, recovery, or recurrence.
• No significant differences in outcomes were found between open, laparoscopic, or robotic RP types, except for operative time.

Conclusions:

• Previous radical prostatectomy should not be an absolute contraindication for totally extraperitoneal laparoscopic inguinal hernia repair.
• TEP LIHR can be performed safely and effectively in patients with a history of RP by experienced surgeons, yielding comparable outcomes.