S. Julie-Ann Lloyd, MD, PhD, Andrew T Strong, MD, JingLiang Yan, MD, PhD, John H Rodriguez, MD, Jeffrey L Ponsky, MD, Matthew D Kroh, MD. Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic
Introduction: Inguinal hernia is a well-known complication of radical prostatectomy, with up to 40% of patients requiring repair within the first two years of surgery. However, it is unclear whether concurrent inguinal hernia repair with prostate resection would be beneficial. This study examines our institution’s experience with simultaneous, minimally invasive hernia repair during robotic-assisted laparoscopic radical prostatectomy.
Methods: We retrospectively reviewed patients who underwent combined robotic-assisted laparoscopic prostatectomy and minimally invasive inguinal hernia repairs between January 2004 and July 2016. Demographics, procedure-related details and outcomes data were then analyzed for this group.
Results: Eighteen patients were identified, including seven with prior abdominal surgery. The mean age and mean BMI were 61.2 ± 8.2 years and 26.7 ± 2.9 kg/m2, respectively. There were eight bilateral hernias; of the 10 unilateral repairs, five were left-sided. Robotic repairs were performed on 15 patients, while three had laparoscopic repairs, and nineteen of 26 hernias (13 patients) were reinforced with permanent mesh. Mean operative time was 273 ± 66 minutes with a median length of stay of 2 days. Median time to follow-up was 24 (IQR 7.4 – 51.4) months. Recurrence was noted in three patients (12.5%), whose direct defects had been covered with mesh and secured with tacks. Two such patients underwent open repair one year after the index surgery. The third was asymptomatic and opted for close observation with no untoward effects during the follow-up period. Although mortality and surgical site infection were nil, other post-operative complications included venous thrombosis (5.6%), bladder leak (2.8%) and post-operative pain (22.2%).
Conclusions: Results from this study on robotic and laparoscopic inguinal hernia repair during prostatectomy support the safety of concomitant surgery. However, an unexpectedly high recurrence rate was noted, suggesting that hernia repair is better deferred for the post-operative period in asymptomatic patients. Further studies with a larger cohort are needed to determine how these results compare with delayed open inguinal hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80489
Program Number: P584
Presentation Session: Poster (Non CME)
Presentation Type: Poster
