Steven Garcia, MD, Monica Morgan, MD, Jeffrey A Cadeddu, MD, Claus Roehrborn, MD, Daniel J Scott, MD. UT Southwestern Medical Center.
Robotic assisted laparoscopic prostatectomy (RALP) has been increasingly used to treat prostate cancer. Patients undergoing RALP have been reported to have an incidence of inguinal hernia between 7 to 21 %. Concurrent inguinal hernia repair may be a viable option, but concerns have been raised regarding the potential for mesh infection due to opening of the genitourinary tract, which classifies this operation as a clean-contaminated case. The purpose of this study was to review our experience in performing concurrent inguinal hernia repair during RALP procedures to determine the incidence of mesh infections and overall clinical outcomes
Methods and procedures:
We performed an IRB-approved retrospective review of the medical records of 236 RALPs performed by two Urologists from 2009 to 2013 at an academic medical center. A total of 16 (6.7%) concurrent hernia repairs were identified. Patients were deemed suitable candidates for concurrent repair after screening urinalysis indicated no active infection. Medical records were reviewed for patient demographics, intraoperative findings, and postoperative outcomes including length of hospital stay, infectious and other complications, recurrence and chronic pain.
16 concurrent RALP and inguinal hernia repairs were performed between February of 2009 to August of 2013. Mean age was 63 years (range 47-79) and BMI 27 Kg/m2 (range 22.9 to 35.9). All patients had a diagnosis of prostate cancer with a Gleason Score of 6.75 (range 6 to 8) and a PSA of 7.13 (range 2.8 to 28). All patients received prophylactic antibiotics preoperatively. 10 repairs were unilateral and 6 were bilateral, 3 of which were detected intra operatively and were not evident preoperatively. Ten repairs were performed by a General Surgeon and 6 by an Urologist. All cases were consisted of a modified TAPP approach using a permanent mesh coated with anti-adhesion barrier with at least partial re-peritonealization to cover the posterior aspect of the mesh. Mesh size was 12 cm by 15 cm and mesh was fixated using titanium helical fasteners. All cases were completed robotically or laparoscopically and there were no intraoperative complications. Average hospital stay was 2.8 days (range 1-15). One (6.25%) patient had a postoperative ileus which resolved with conservative treatment (15 day stay). Mean follow-up by clinical exam was 24 months (range 19 days-54 months). There were no mesh or skin infections (0/16). There was one (6.25%) hernia recurrence showed a 2 cm fat-containing inguinal hernia that was asymptomatic and managed conservatively. One (6.25%) patient had right groin pain which resolved after 6 months of treatment with non-steroidal anti-inflammatory drugs.
Although our series is limited in numbers, our experience over a 4.5 year period supports the safety and efficacy of concurrent inguinal hernia repair during RALP. Importantly there were no mesh infections and no significant complications.