Simple method for preventing inguinal hernias after radical retropubic prostatectomy

Abstract

Purpose:Inguinal hernias often occur after radical retropubic prostatectomy (RRP). We present a novel and simple technique for preventing inguinal hernias after RRP, which any surgeon can complete within a few minutes.Methods:A total of 230 Japanese prostate cancer patients underwent RRP between January 2007 and September 2011. From July 2009, 115 patients underwent inguinal hernia prevention procedures at the same time as RRP. In this procedure, we released approximately 5 cm of the bilateral vas deferens and spermatic vessels from the peritoneum. In cases in which the processus vaginalis had spread into the abdomen, we ligated it close to the peritoneal cavity and then transected it. The remaining 115 patients who underwent RRP but did not undergo the hernia prevention procedure were used as the control group. The incidence rate of postoperative inguinal hernia was compared between the 2 groups.Results:Inguinal hernias developed during the postoperative follow-up period in 18 of the 115 control patients (15.7%) (median duration, 50 months). The hernia-free survival rate of this group was 89.6% and 84.1% at 1 and 2 postoperative years, respectively. In contrast, only 1 of the 115 patients (0.87%) who underwent the hernia prevention procedure developed an inguinal hernia during the follow-up period (median duration, 27 months). The hernia-free survival rate of this group was 100% at both 1 and 2 postoperative years (P<0.0001).Conclusions:We developed a simple method for preventing post-RRP inguinal hernias. The procedure is easy to perform and produces excellent outcomes.

Incidence and risk factors of inguinal hernia occurred after radical prostatectomy-comparisons of different approaches

“…Hori et al bluntly detached peritoneum at the internal ring so as to isolate spermatic cord, merely 3% of RRP patients in prevented group developed PIH compared to 19% in non-prevented group [ 27 ]. Another effective procedure, opening the spermatic sheath and releasing approximately 5 cm bilateral vas deferens and spermatic vessels from the peritoneum, resulted in 0.87% PIH rate in prevented group while 15.7% non-prevented patients suffered from PIH, was introduced by Koike in 2013 [ 28 ]. The conceivable principle of these manipulations was that the scar tissues formed by isolating the spermatic cord could easily help to strengthen the internal ring.…”

Incidence and risk factors of inguinal hernia after robot-assisted radical prostatectomy: a retrospective multicenter cohort study in Japan (the MSUG94 group)

“…Thus far, several surgical procedures have been proposed for post-RARP IH prevention. Some researchers have proposed separating the processus vaginalis from the perineum and/or vas deferens [21][22][23][24]. Lee et al reported a simple method in cases of patent processus vaginalis (PPV) which consists of transecting the PPV, plugging a hemostatic agent into the detached canal end, and suture closing the internal inguinal oor [25].…”

“…Various surgical procedures have been proposed as means of preventing IH after RARP, including separating the processus vaginalis from the perineum and/or the vas deferens [21][22][23][24], plugging hemostatic agents into the inguinal canal and suture closing the internal inguinal ring (IIR) [25], su ciently incising the peritoneum around the IIR, separating the spermatic vessels, and dissecting and cutting the vas deferens [19,26]. However, none of these methods have been established or standardized for RARP.…”

Incidence And Risk Factors Of Inguinal Hernia Occurred After Radical Prostatectomy-comparisons of different approaches

“…Hori et al bluntly detached peritoneum at the internal ring so as to isolate spermatic cord, merely 3% of RRP patients in prevented group developed PIH compared to 19% in non-prevented group [28]. Another effective procedure, opening the spermatic sheath and releasing approximately 5 cm bilateral vas deferens and spermatic vessels from the peritoneum, resulted in 0.87% PIH rate in prevented group while 15.7% non-prevented patients suffered from PIH, was introduced by Koike in 2013 [29]. The conceivable principle of these manipulations was that the scar tissues formed by isolating the spermatic cord could easily help to strengthen the internal ring.…”