Up to a third of men undergoing radical prostatectomy (RP) have a comorbid inguinal hernia. Previous studies have shown adding total extraperitoneal inguinal hernia repair (TEP) to extraperitoneal laparoscopic radical prostatectomy (LRP) lacks adverse effects.
However, outcomes for extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALP) and TEP are unknown. We compared RALP+TEP to LRP+TEP and to RALP alone.
11 RALP+TEP cases were retrospectively compared to 26 LRP+TEP cases and 22 control RALP without TEP. Outcomes compared between groups included operative time, estimated blood loss (EBL), discharge hematocrit, time to diet advancement, length of stay (LOS), post-operative complications and hernia recurrence.
Unilateral TEP added 32 min to RALP and 31 min to LRP, while bilateral TEP added 80 min to RALP and 36 min to LRP. There were no differences between RALP+TEP and LRP+TEP or RALP without TEP controls in regards to EBL, discharge hematocrit, time to diet advancement, LOS or post-operative complications. One patient developed an anterior mesh seroma, which resolved without intervention. No inguinal hernia recurrences were noted on mean follow-up of 33 months in the RALP group and 50 months in the LRP cohort.
Unilateral and bilateral TEP added operative time to RALP, but had equivalent outcomes to both LRP+TEP and RALP alone. This is likely due to the similar surgical space used for RALP and TEP, which obviates the need for substantial further dissection. For men with prostate cancer and comorbid inguinal hernia, combined RALP+TEP appears to be an appropriate surgical combination.
Journal of endourology / Endourological Society. 2015 Sep 28 [Epub ahead of print]
Wesley Ludwig, Nikolai Sopko, Said C Azoury, Andrew Dhanasopon, Anirudh Dwarakanath, Lynda Mettee, Kimberley E Steele, Hien T Nguyen, Christian Pavlovich
Johns Hopkins Hospital, Urology, Baltimore, Maryland, United States ; Johns Hopkins Hospital, Urology, Baltimore, Maryland, United States ; Johns Hopkins Hospital, General Surgery, Baltimore , Maryland, United States ; Johns Hopkins Hospital, General Surgery, Baltimore , Maryland, United States ; Johns Hopkins Hospital, General Surgery, Baltimore , Maryland, United States ; Johns Hopkins Hospital, Urology, Baltimore, Maryland, United States. , Johns Hopkins Hospital, General Surgery, Baltimore , Maryland, United States ; Johns Hopkins Hospital, General Surgery, Baltimore , Maryland, United States ; Johns Hopkins, Urology, Baltimore, Maryland, United States