Philip A Le Page, MBBS, hons, Doug Fenton-Lee, AssProf, Ania Smialkowski, Dr, John Morton, Dr
St. Vincent’s Hospital, Sydney
Introduction.
The laparoscopic Total Extra-Peritoneal (TEP) approach to inguinal hernia repair is facilitated by balloon dissection of the extraperitoneal space. Prostatectomy can produce adhesions which can obliterate the extraperitoneal plane. Historically, laparoscopic (TEP) surgery for these patients would be contra-indicated, however the benefits of the TEP approach, particularly with reduced pain and early return to work, may benefit these patients too. The aim of our study was to assess the feasibility, safety and outcomes of the TEP approach for hernia repair in patients having had a previous prostatectomy
Methods:
A retrospective case control study was conducted on patients undergoing Laparoscopic (TEP) hernia repair between 2004 and 2011 at St Vincent’s Hospital, Sydney. There were 52 consecutive cases undergoing TEP hernia repair who had a previous prostatectomy and they were matched to 102 control cases. Clinical data for both groups was collected from the hospital records.
Surgery was undertaken by accessing the infraumbilical extra-peritoneal plane and insufflating the space with balloon and then CO2. Careful dissection of the hernia and cord structures was undertaken followed by placement of parietex mesh. In cases following prostatectomy, the same process was followed but adhesions were carefully dissected, and when bilateral, separate incision and insufflation was undertaken either side of the midline.
Outcome data was obtained from notes and contacting patients by phone and mail and included operative time, intraoperative complications, conversion rate, length of hospital stay, post operative complications (including wound complications and pain) and early and late recurrence.
Results:
| Previous prostatectomy n=52 | Control Group n=102 | |
| Average age (years) | 69 | 67 |
| ASA status (median) | 2 | 2 |
| Mean F/U (mths) | 22 | 14 |
| Mean Operative time (minutes) | 76 | 54 |
| # Intraoperative complications | 0 | 0 |
| # Conversion to open surgery | 1 | 0 |
| Minor post-op complications (%) | 15 | 11 |
| Major post-op complications (%) | 0 | 0 |
| Hernia recurrence (%) | 0 | 1% |
| Mean length of stay (days) | 1.5 | 1.3 |
| Chronic pain (%) | 9 | 12 |
| Patient Satisfaction (%) | 100 | 100 |
Conclusion:
This study shows that TEP hernia surgery following prostatectomy is a feasible and safe procedure when conducted in experienced hands, with equivalent low complication, recurrence and pain rate compared to patients not having undergone this previous surgery. Importantly no intra-operative, major complications or recurrence were encountered in this group. Operative time is modestly longer and understandable given the adhesions, and may be justified given the benefits of early discharge and less post-operative pain. Further study dedicated to quality of life issues and comparison to open repair would clarify this.
Session: Podium Presentation
Program Number: S018