Repair of Inguinal Hernias Using the Mesh Technique during Extraperitoneal Pelvic Lymph Node Dissection

Abstract

Purpose: This article describes our experience of using a totally extraperitoneal approach for endoscopic pelvic lymphadenectomy and inguinal hernia repair with the mesh technique in one procedure. Materials and Methods: A total of 52 patients underwent modified pelvic lymph node dissection for the staging of prostate cancer. Eight of them had hernia defects; 1 was recurrent. Five patients with direct and 3 patients with indirect inguinal hernias were treated by totally extraperitoneal hernia repair with the placement of a mesh measuring at least 10 × 15 cm (prolene mesh with incision and flap). Results: The mean duration of the lymphadenectomy itself was decreased from 150 min (first 20 patients) to 70 min (n = 21–52). The mean additional procedure time for hernioplasty was 15 min. The overall lymph node-positive rate was 9.6%. The complication rate was 7.7%. Four patients developed symptomatic lymphoceles, 1 of whom developed deep venous thrombosis. No complications occurred which were attributed to hernia repair. Morbidity did not rise, and hospitalization time did not increase for the patients who underwent hernioplasty. There were no recurrences or neuralgias on follow-up up to 2 years. Conclusions: By avoiding entry into the peritoneal cavity, the extraperitoneal approach obviates intra-abdominal complications (ileus, bowel injury, peritonitis) in both techniques. The extraperitoneal approach for pelvic lymph node dissection allows concomitant inguinal hernia to be repaired with low morbidity and within an acceptable operating time.

Technique of laparoscopic (endoscopic) radical prostatectomy

“…Especially in elderly men, the incidence of inguinal hernia is relatively high. Different authors reported a concomitant inguinal hernia repair during endoscopic extraperitoneal pelvic lymph node dissection [35,36]. In these studies, the rate of inguinal hernias was 12.9-18.3%.…”

“…We prefer a standardized TEP technique, which uses the principle of tension-less hernia repair, overlaying the entire myopectineal orifice with one large piece of mesh [36,37]. The mesh is 10 ¥ 15 cm; it is incised in the middle and a small hole cut into the mesh to provide sufficient space for the spermatic cord.…”

Hernia Repair During Endoscopic (Laparoscopic) Radical Prostatectomy

“…7,9,10 Furthermore, the extraperitoneal endoscopic hernia repair can be safely performed with endoscopic extraperitoneal lymph node dissection during one procedure. 11,12 28 STOLZENBURG ET AL.…”