An inguinal hernia that arose after robot‐assisted radical prostatectomy and the repair of an intraoperative external iliac vein injury: A case report

Abstract

This case involved a 63‐year‐old man. He underwent robot‐assisted radical prostatectomy (RARP) for prostate cancer. One year after the operation, he consulted our hospital about left inguinal swelling. Under a diagnosis of a left external inguinal hernia, transabdominal preperitoneal repair (TAPP) was performed under general anesthesia. The inside of the hernia orifice had been damaged by the RARP, and the resultant fibrosis was so marked that it was difficult to dissect the preperitoneal space. Furthermore, an external iliac vein injury occurred during the operation. The bleeding was controlled, and we used laparoscopic continuous non‐absorbable sutures to repair the external iliac vein injury. The number of TAPP procedures performed after radical prostatectomy has been increasing in recent years, but dissecting the preperitoneal space inside a hernia orifice is difficult. Although external iliac vein injuries are rare complications of TAPP procedures, they can be laparoscopically repaired.

A case of direct inguinal hernia incarceration after transperitoneal robot‐assisted radical prostatectomy

“…With regard to repair of DIH after RARP, the preferred repair method is an anterior approach with a prosthetic mesh, especially the Lichtenstein method 6 . This method does not require manipulation in the preperitoneal space.…”

“…Furthermore, even when a concomitant intra‐abdominal infection occurs, hernia repair using the anterior approach may be easily performed without a mesh. In contrast, the advantages of the laparoscopic approach, which have recently been increasing, 6,7 include an accurate diagnosis of the inguinal hernia and contralateral inguinal hernia and a faster recovery with less chronic pain 8 . In addition, infection in the abdominal cavity and necrosis of the incarcerated intestine after reduction can be detected using laparoscopy 9 .…”

“…With regard to repair of DIH after RARP, the preferred repair method is an anterior approach with a prosthetic mesh, especially the Lichtenstein method. 6 This method does not require manipulation in the preperitoneal space. In addition, the risk of adhesion between the mesh and the intestine is small, even if the peritoneum of the hernia orifice is defective after RARP.…”

“…8 In addition, infection in the abdominal cavity and necrosis of the incarcerated intestine after reduction can be detected using laparoscopy. 9 However, the disadvantages of the laparoscopic approach include the requirement for preperitoneal dissection after RARP with technical difficulty due to the postoperative adhesion 3,6 and possibility of the mesh not being fully covered by the peritoneum due to the deficient peritoneum. In the present case, it appears that the laparoscopic approach had advantages in dissecting intracorporeal adhesions from inside the abdominal cavity with preservation of the transverse fascia and in diagnosing the contralateral hernia.…”