Shuto Fujita, MD, Hitoshi Idani, MD, FACS, Kanyu Nakano, MD, Toshihiro Ogawa, MD, Yasuhiro Komatsu, MD, Naoki Mimura, MD, Tetsushi Kubota, MD. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Background: Inguinal hernia developed after robot- assisted laparoscopic radical prostatectomy (RALP) have usually been treated by anterior approach. We have introduced a new technique of laparoscopic transabdominal repair of inguinal hernia after RALP and evaluated the outcome.
Surgical procedures: Under general anesthesia, 3 trocars was inserted at the same position as transabdominal preperitoneal approach (TAPP). Bilateral inguinal legion was observed carefully and bilateral hernia repair was performed when the hernia was detected at the contralateral side. At first, preperitoneal space was dissected laterally and then medially enough to detect the Cooper’ ligament and pubic bone. When the Cooper,s ligament could not be detected, the surgery was converted to anterior approach. When the preperitoneal space was fully dissected, TAPP was performed with 14X10 cm mesh. When the Cooper’s ligament was detected but the medial preperitoneal space could not be further dissected due to scar formation caused by dissection during RALP, parietex composition mesh was fixed to the Cooper’s ligament and medial and cephalad side was directly fixed to the abdomen and the caudal side was sutured and covered with peritoneum (modified intraperitoneal onlay mesh: MIPOM).
Methods: From April 2014 to August 2017, 15 patients with inguinal hernia developed after RALP underwent laparoscopic repair in our hospital and its short-term outcome was evaluated.
Results: Mean age of patients was 69 years old. There were 8 right indirect hernias, 2 left indirect hernia and 5 bilateral indirect hernias (one of which was combined with left direct hernia). Two Contralateral side hernias were diagnosed during laparoscopy. TAPP, MIPOM and anterior approach were performed on 4, 7 and 4 patients, respectively. Operation time was 142 min for TAPP, 150 min for PIPOM (including 2 bilateral repair) and 144 min for anterior approach. Postoperative pain was minimum and well controlled by painkiller which disappeared within a week. Hospital stay was 3.5 days. Seroma was occurred in two patients after MIPOM, one of which was treated conservatively. The other was symptomatic and recurrence could not completely be denied and laparoscopy was performed. By laparoscopy, the mesh was beautifully incorporated without recurrence and the remnant hernia sac was resected by anterior approach. During the follow-up period of 26 months, there has been no recurrence.
Conclusion: Our new laparoscopic repair including TAPP and MIPOM is safe and effective although further examination in a large number of patients and long term follow up will be needed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87157
Program Number: P015
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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