Simple Method of Preventing Postoperative Inguinal Hernia After Radical Retropubic Prostatectomy

Taguchi, Kazumi; Yasui, Takahiro; Kubota, Hirokazu; Fukuta, Katsuhiro; Kobayashi, Daichi; Naruyama, Hiromichi; Okada, Atsushi; Yamada, Yasuyuki; Tozawa, Keiichi; Kohri, Kenjiro

doi:10.1016/j.urology.2010.05.002

Cited by 25 publications

(21 citation statements)

References 17 publications

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“…Stranne et al [19] showed that narrowing the IIR with non-absorbable figure-of-8 suture led to decreased IH incidence in a large prospective study. Recently, non-mesh techniques have been reported [8][9][10] . The concept of these techniques was separation from the peritoneum and division of the continuity between processus vaginalis and peritoneum.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Shimbo

Endo²,

Matsushita³

et al. 2016

Urol Int

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Introduction: To evaluate the incidence and risk factors for postoperative inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) and to assess whether a newly developed prevention technique reduces the incidence of IH after RARP. Methods: We included 161 consecutive patients (322 groins) who underwent RARP between September 2011 and October 2013. The prevention technique was as follows: (1) sufficient incision of peritoneum around the internal inguinal ring; (2) separation of spermatic vessels; (3) dissection of vas deferens. Results: Postoperative IH occurred in 14 cases (19.4%) occurring in the observation group compared to 2 cases (2.2%) in the prevention group. Patent processus vaginalis (PPV) was the only risk factor. Time-to-event analysis demonstrated a significant decrease in IH incidence in the IH prevention group (p = 0.005). Conclusion: Our data reveal a higher incidence of IH after RARP, with the existence of PPV as the only identified risk factor. Our simple IH-prevention technique, which does not involve the use of artificial materials, appears safe and effective.

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Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Shimbo

Endo²,

Matsushita³

et al. 2016

Urol Int

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“…Fujii et al [18] stated that they could not precisely evaluate the appearance of the processus vaginalis until the spermatic cord had been opened and the processus vaginalis had been dissected. On the other hand, Taguchi et al [19] released the bilateral spermatic cords from the peritoneum and manually separated at least 5 cm of the peritoneum from the abdominal wall as a hernia prevention procedure in 101 patients. None of the patients who underwent this procedure developed IH during a mean follow-up period of 11.6 months.…”

Section: Discussionmentioning

confidence: 99%

“…None of the patients who underwent this procedure developed IH during a mean follow-up period of 11.6 months. Taguchi et al [19] identified the vaginal process of the peritoneum, but did not use any ligatures. This procedure was supposed to prevent the intestinal tract inside the peritoneum from protruding through the internal inguinal tract.…”

Section: Discussionmentioning

confidence: 99%

Simple method for preventing inguinal hernias after radical retropubic prostatectomy

Koike

Matsui

Morikawa

et al. 2013

Prostate International

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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.

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“…Another group from Japan retrospectively evaluated releasing the bilateral spermatic cords from the peritoneum before wound closure as well as manually freeing at least 5 cm of peritoneum from the abdominal wall to prevent bowel from herniating through the internal inguinal ring after prostatectomy [ 15 ] . Of the 101 patients who underwent the prophylactic procedure, no patient had developed an IH at approximately 1 year of follow up.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post‐prostatectomy hernia

et al. 2012

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What ' s known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias.To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to < 1%. OBJECTIVE• To assess if a comprehensive evaluation to diagnose clinical and subclinical hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. PATIENTS AND METHODS• Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon.• Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging.• Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. RESULTS• Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality.• Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs.• No preoperative factor was signifi cantly associated with the presence of an IH before prostatectomy.• No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not undergo repair of their preoperatively diagnosed IH at the time of ORRP ( P = 0.024).• Only one (0.4%) clinical IH developed in a groin that had no evidence of IH by physical examination, upstanding ultrasonography and magnetic resonance imaging before prostatectomy. CONCLUSIONS• Our comprehensive evaluation increases the detection of IHs before ORRP.• Repair of these IHs at the time of ORRP signifi cantly decreases the risk of developing post-prostatectomy clinical IHs. KEYWORDSprostate cancer , prostatectomy , inguinal hernia , ultrasonography , magnetic resonance imaging Study Type -Therapy (case series) Level of Evidence 4

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Simple Method of Preventing Postoperative Inguinal Hernia After Radical Retropubic Prostatectomy

Cited by 25 publications

References 17 publications

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Simple method for preventing inguinal hernias after radical retropubic prostatectomy

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post‐prostatectomy hernia

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