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Kasakewitch JPG, da Silveira CAB, Lima DL, Rasador ACD, Kasmirski J, Eguchi M, Sanha V, Malcher F. Is previous prostatectomy a risk factor for postoperative complications following minimally invasive inguinal hernia repair? A systematic review and meta-analysis. Surg Endosc 2024:10.1007/s00464-024-11207-w. [PMID: 39192039 DOI: 10.1007/s00464-024-11207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/18/2024] [Indexed: 08/29/2024]
Abstract
AIM The literature indicates that patients with prior pelvic surgery, particularly radical prostatectomy, pose challenges in minimally invasive inguinal hernia repair (IHR). However, there is no conclusive evidence regarding the impact of pelvic surgery on postoperative complications. To address this gap, we conducted a systematic review and meta-analysis to evaluate the influence of previous prostatectomy in men undergoing MIS IHR. MATERIALS AND METHODS We searched Cochrane Central, Scopus, SciELO, Lilacs, and PubMed/MEDLINE for studies comparing men undergoing MIS IHR after prostatectomy with men without previous pelvic surgery. Key outcomes evaluated included recurrence, overall postoperative complications, seroma, hematoma, surgical site infection (SSI), conversion rates, and operative time. RESULTS Out of 402 screened studies, 9 met the inclusion criteria. Among the included studies, three analyzed totally extraperitoneal (TEP) technique, while four analyzed transabdominal preperitoneal (TAPP) and two presented both techniques together. The analysis comprised 189,183 patients, of which 4551 (2.4%) had a history of prostatectomy. The analysis revealed that post-prostatectomy patients presented higher postoperative complications (3.7% vs. 1.9%; RR 1.9; 95% CI [1.23; 2.94]; P = 0.004) and seroma (1.6% vs. 0.9%; RR 1.58; 95% CI [1.23; 2.04]; P < 0.001) following MIS IHR. Additionally, patients with a previous prostatectomy presented an increased operative time (MD 21.25 min; 95% CI [19.1; 23.4]; P < 0.001). No significant differences were observed in recurrence (0.98% vs. 0.92%; RR 1.1; 95% CI [0.8; 1.53]; P = 0.54), SSI (0.07% VS. 0.07%; RR 0.99; 95% CI [0.34; 2.9]; P = 0.98), hematoma (3.6% vs. 1.2%; RR 3.18; 95% CI [0.84; 12.1]; P = 0.09), and conversion rates (1.1% vs. 0.9%; RR 1.26; 95% CI [0.91; 1.72]; P = 0.16). However, subgroup analysis of TEP technique in patients with previous prostatectomy showed higher conversion rates (2.4% vs. 0%; RR 20; 95% CI [2.9; 138.2]; P < 0.01). Analysis using funnel plots showed the absence of publication bias in the study outcomes. CONCLUSION This comprehensive analysis indicates that patients with a history of prostatectomy undergoing MIS IHR may present higher postoperative complications and an increased operative time. Further comparative studies are needed to evaluate the cumulative impact of MIS IHR in patients with previous prostatectomy.
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Affiliation(s)
- João P G Kasakewitch
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, NY, USA.
| | | | - Julia Kasmirski
- Department of Surgery, University of Alabama, Birmingham, AL, USA
| | - Marina Eguchi
- Departamento de Cirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Valberto Sanha
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Flavio Malcher
- Division of General Surgery, NYU Langone Health, New York, NY, USA
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Aiolfi A, Bona D, Calì M, Manara M, Bonitta G, Cavalli M, Bruni PG, Carmignani L, Danelli P, Bonavina L, Köckerling F, Campanelli G. Is previous radical prostatectomy a contraindication to minimally invasive inguinal hernia repair? A contemporary meta-analysis. Hernia 2024:10.1007/s10029-024-03098-6. [PMID: 38990229 DOI: 10.1007/s10029-024-03098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Traditionally, radical prostatectomy (RP) has been considered a contraindication to minimally invasive inguinal hernia repair. Purpose of this systematic review was to examine the current evidence and outcomes of minimally invasive inguinal hernia repair after RP. MATERIALS AND METHODS Web of Science, PubMed, and EMBASE data sets were consulted. Laparoscopic transabdominal preperitoneal repair (TAPP), robotic TAPP (r-TAPP), and totally extraperitoneal (TEP) repair were included. RESULTS Overall, 4655 patients (16 studies) undergoing TAPP, r-TAPP, and TEP inguinal hernia repair after RP were included. The age of the patients ranged from 35 to 85 years. Open (49.1%), laparoscopic (7.4%), and robotic (43.5%) RP were described. Primary unilateral hernia repair was detailed in 96.3% of patients while 2.8% of patients were operated for recurrence. The pooled prevalence of intraoperative complication was 0.7% (95% CI 0.2-3.4%). Bladder injury and epigastric vessels bleeding were reported. The pooled prevalence of conversion to open was 0.8% (95% CI 0.3-1.7%). The estimated pooled prevalence of seroma, hematoma, and surgical site infection was 3.2% (95% CI 1.9-5.9%), 1.7% (95% CI 0.9-3.1%), and 0.3% (95% CI = 0.1-0.9%), respectively. The median follow-up was 18 months (range 8-48). The pooled prevalence of hernia recurrence and chronic pain were 1.1% (95% CI 0.1-3.1%) and 1.9% (95% CI 0.9-4.1%), respectively. CONCLUSIONS Minimally invasive inguinal hernia repair seems feasible, safe, and effective for the treatment of inguinal hernia after RP. Prostatectomy should not be necessarily considered a contraindication to minimally invasive inguinal hernia repair.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy.
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Matteo Calì
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Michele Manara
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Marta Cavalli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Piero Giovanni Bruni
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Luca Carmignani
- Division of Urology, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piergiorgio Danelli
- Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L. Sacco University Hospital, 20157, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - Giampiero Campanelli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
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Yamamoto T, Hyakudomi R, Takai K, Uchida Y, Ishitobi K, Hirahara N, Tajima Y. High peritoneal incision approach in endoscopic transabdominal preperitoneal patch plasty (TAPP) for inguinal hernia after radical prostatectomy. Asian J Endosc Surg 2024; 17:e13353. [PMID: 38991552 DOI: 10.1111/ases.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/21/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Inguinal hernia develops as one of the common complications after robotic or laparoscopic radical prostatectomy (RP). Transabdominal preperitoneal patch plasty (TAPP) for an inguinal hernia after RP is difficult to perform due to postoperative severe adhesions in the preperitoneal cavity. We have introduced a high peritoneal incision approach (HPIA) in TAPP for inguinal hernia patients in whom peritoneal dissection is difficult due to severe adhesions after RP. We evaluate the safety and efficacy of TAPP with a HPIA for patients with an inguinal hernia after robot-assisted RP (RARP). METHODS Patients characteristics and surgical outcome were evaluated by a retrospective analysis. RESULTS From January 2014 to December 2017, 21 consecutive patients underwent TAPP for an inguinal hernia after RARP. Twenty-four lesions were the type 3b and three were type 3a according to the Nyhus classification. A circular incision TAPP was performed for 10 hernia lesions in eight patients and TAPP with HPIA was utilized for 17 lesions in 13 patients. The mean operation time for the unilateral hernia in the HPIA (137.8 ± 20.7 min) was significantly shorter than that (182.2 ± 42.0 min) in the circular incision TAPP (p = .038). The HPIA was complete in all patients, while the circular incision TAPP was converted to intraperitoneal onlay mesh (IPOM)intraperitoneal onlay mesh in five patients (55.6%, p = .008) due to dense adhesions with difficult dissection. No recurrent was observed after follow-up period of 48 months in both groups. CONCLUSIONS The TAPP with HPIA is feasible and a safe and reliable treatment of choice in patients with an inguinal hernia after RARP.
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Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Jin X, Chu Q, Bing H, Li F, Bai J, Lou J, Sun L, Zhang C, Lin L, Li L, Wang H, Zhou Z, Zhang J, Lian H. Preperitoneal pelvic balloon tamponade-an effective intervention to control pelvic injury hemorrhage in a swine model. Front Bioeng Biotechnol 2024; 12:1340765. [PMID: 38737537 PMCID: PMC11082274 DOI: 10.3389/fbioe.2024.1340765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Objective: This study aimed to estimate the effects of the volume of preperitoneal balloon (PPB) on arterial and venous hemorrhage in a swine pelvic fracture model. Methods: Twenty-four swine were randomized into 0-mL, 500-mL, 800-mL, and 1000-mL intra-hematoma PPB groups. They were subjected to open-book pelvic fracture and reproducible injuries in the external iliac artery and vein. The pelvic binder and IH-PPBs with different volumes of fluid were applied to control the active hemorrhage after arterial and venous injuries. The survival time and rate during 60-min observation and digital subtraction angiography (DSA) images were the primary endpoints in this study. Secondary endpoints included survival rate within 70 min, peritoneal pressure, hemodynamics, blood loss, infusion fluid, blood pH, and lactate concentration. Results: Our results indicated that the 800-mL and 1000-mL groups had a higher survival rate (0%, 50%, 100% and 100% for 0, 500, 800, and 1000-mL groups respectively; p < 0.0001) and longer survival time (13.83 ± 2.64, 24.50 ± 6.29, 55.00 ± 6.33, and 60.00 ± 0.00 min for 0, 500, 800, and 1,000 groups respectively; p < 0.0005) than the 0-mL or 500-mL groups during the 60 min observation. Contrastingly, survival rate and time were comparable between 800-mL and 1000-mL groups during the 60-min observation. The IH-PPB volume was associated with an increase in the pressure of the balloon and the preperitoneal pressure but had no effect on the bladder pressure. Lastly, the 1000-mL group had a higher mean arterial pressure and systemic vascular resistance than the 800-mL group. Conclusion: IH-PPB volume-dependently controls vascular bleeding after pelvic fracture in the swine model. IH-PPB with a volume of 800 mL and 1000 mL efficiently managed pelvic fracture-associated arterial and venous hemorrhage and enhanced survival time and rate in the swine model without evidences of visceral injury.
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Affiliation(s)
- Xiaogao Jin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Hailong Bing
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Fang Li
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jingyue Bai
- Department of Orthopedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Junge Lou
- Department of Peripheral Vascular Intervention, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liwei Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Chenxi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Lin Lin
- Department of Ultrasound Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liumei Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Haibo Wang
- Department of Orthopedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhanfeng Zhou
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Junfeng Zhang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongkai Lian
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Department of Ultrasound Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Research of Trauma Center, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Lee SR. Efficacy of Laparoscopic Iliopubic Tract Repair Plus Transabdominal Preperitoneal Hernioplasty for Treating Inguinal Hernia After Robot-assisted Radical Prostatectomy. Surg Laparosc Endosc Percutan Tech 2023; 33:276-281. [PMID: 37058476 PMCID: PMC10234324 DOI: 10.1097/sle.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) is a risk factor for inguinal hernia (IH). Furthermore, in patients who have undergone RARP, the fibrotic scar tissue in the RARP area limits preperitoneal dissection. This study aimed to evaluate the efficacy of performing laparoscopic iliopubic tract repair (IPTR) in addition to transabdominal preperitoneal hernioplasty (TAPPH) to treat IH after RARP. PATIENTS AND METHODS A total of 80 patients with an IH after RARP were treated with TAPPH from January 2013 to October 2020 and were included in this retrospective study. Patients who underwent conventional TAPPH were categorized as the TAPPH group (25 patients with 29 hernias), whereas those who underwent TAPPH with IPTR were categorized as the TAPPH + IPTR group (55 patients with 63 hernias). The IPTR comprised suture fixation of the transversus abdominis aponeurotic arch to the iliopubic tract. RESULTS All patients had indirect IH. The incidence of intraoperative complications was significantly higher in the TAPPH group than in the TAPPH + IPTR group [13.8% (4/29) vs 0.0% (0/63), P = 0.011]. The average operative time was also significantly shorter in the TAPPH + IPTR group than in the TAPPH group ( P < 0.001). There were no differences between the two groups in the duration of hospitalization, recurrence rate, and pain severity. CONCLUSIONS The addition of laparoscopic IPTR to TAPPH for treating IH after RARP is safe and is associated with a minimal risk of intraoperative complications and a short operative time.
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Lade C, Ford H, Venincasa K, Lewis S, Lee B, Harmon A, Choi P, Raines A. No prostate? No problem: robotic inguinal hernia repair after prostatectomy. J Robot Surg 2023:10.1007/s11701-023-01586-y. [PMID: 37022558 PMCID: PMC10078048 DOI: 10.1007/s11701-023-01586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023]
Abstract
Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1 month. Mean follow-up time was 8.0 months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.
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Affiliation(s)
- Caleb Lade
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA.
| | - Hunter Ford
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Kiran Venincasa
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Samara Lewis
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Benjamin Lee
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Allison Harmon
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Preston Choi
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Alexander Raines
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
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Arici S. Evaluation of the Factors Influencing on Intraoperative Difficulty Scores of Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2022; 32:1097-1101. [PMID: 36040346 DOI: 10.1089/lap.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inguinal hernias are the leading surgical diseases in the world. There are different surgical procedures reported for the treatment. Some problems are thought to be encountered when performing laparoscopic surgery in these patients, such as risk of severe complications and the prolonged operative duration. Aim: The objective of this study was to specify the complexity of the transabdominal preperitoneal (TAPP) procedure by using an intraoperative scoring system and examine the scores with these patients' predictive factors. Materials and Methods: A prospective study was conducted in patients who underwent inguinal hernia surgery with TAPP. Previous lower abdominal surgery, previous (open) hernia surgery, body mass index (BMI), type of hernia, duration of the surgery, scoring the difficulty of the operation in five various stages using the visual analog scale (VAS) score (1. Mobilizing the peritoneum/dissection of the inferior peritoneal flap. 2. Dissection of internal ring or vas deference or hernia sac. 3. Visualization of Cooper's ligament. 4. Mesh placement. 5. Peritoneal closure.) and the time of discharge were recorded. Results: In this study, 137 patients were included. "BMI" and "previous lower abdominal surgery" have significantly higher scores, time of surgery, and hospital stay compared with other risk factors (P < .005). Conclusion: This study showed that patient's BMI and previous lower abdominal surgery could create technical difficulty with the TAPP procedure, but it is not necessary to avoid this laparoscopic technique because of these situations and can be performed safely.
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Affiliation(s)
- Sinan Arici
- Department of General Surgery, T.C. Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Bakker WJ, Roos MM, Meijer RP, Burgmans JPJ. Influence of previous laparo-endoscopic inguinal hernia repair on performing radical prostatectomy: a nationwide survey among urological surgeons. Surg Endosc 2020; 35:2583-2591. [PMID: 32488655 DOI: 10.1007/s00464-020-07676-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is considerable demographic overlap of inguinal hernia patients and prostate cancer patients. Previous laparo-endoscopic inguinal hernia mesh repairs can complicate subsequent radical prostatectomies due to adhesions and distortion of anatomic planes. This study aims to assess the experience of urological surgeons on the safety and feasibility of performing radical prostatectomies after laparo-endoscopic inguinal hernia mesh repair. METHODS For this cross-sectional study, an online 24 question survey was developed regarding the experience in performing a radical prostatectomy and pelvic lymph node dissection (PLND) with a prior preperitoneal inguinal hernia mesh repair. Between June 2016 and December 2017, the questionnaire was sent to all 68 urological surgeons performing radical prostatectomy in the Netherlands. RESULTS The response rate of urological surgeons was 69% (n = 47). The majority (77%) of urological surgeons perform robot-assisted laparoscopic prostatectomies. A previous preperitoneal inguinal hernia repair was reported by 40% of urological surgeons in 10-30% of patients undergoing radical prostatectomy. Radical prostatectomy with prior preperitoneal inguinal hernia mesh repair is considered more difficult by 49%, predominantly because of (occasionally to always) experienced longer operating times (88.4%), increased blood loss (46.5%), difficult dissection of Retzius space (88.4%), nerve-sparing difficulties (32.6%), less adequate PLND (69.8%), and bladder- (16.3%) or peritoneal perforations (27.9%). Additionally, 11.6% had performed mesh explantation, 16.3% had aborted radical prostatectomies, and 35.7% experienced increased inguinal hernia recurrences after radical prostatectomies with prior preperitoneal inguinal hernia mesh repair. More experienced urological surgeons reported an increased difficulty for all outcomes. CONCLUSIONS Laparo-endoscopic inguinal hernia mesh repair has a significant impact on performing a radical prostatectomy and PLND. Surgeons should postpone the inguinal hernia repair of patients in the workup for a radical prostatectomy, with the preferable option of performing the radical prostatectomy and inguinal hernia repair in the same procedure. Alternatively, a Lichtenstein repair can be performed.
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Affiliation(s)
- Wouter J Bakker
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
| | - Marleen M Roos
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josephina P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
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Ohuchi M, Inaki N, Nagakari K, Kohama S, Sakamoto K, Ishizaki Y. Surgical Procedures and Results of Modified Intraperitoneal Onlay Mesh Repair for Inguinal Hernia After Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2020; 30:1189-1193. [PMID: 32343621 DOI: 10.1089/lap.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although inguinal hernia occurs frequently after radical prostatectomy, transabdominal preperitoneal (TAPP) inguinal hernia repair occasionally poses challenges due to fibrosis of the preperitoneal cavity. In patients with severe intrapelvic fibrosis, we have adopted a modified intraperitoneal onlay mesh (IPOM) technique. The surgical factors were compared between patients who underwent modified IPOM and those who underwent TAPP for inguinal hernia repair. Materials and Methods: In total, 57 patients underwent laparoscopic surgery for inguinal hernias after radical prostatectomy between February 2013 and January 2020. TAPP was successfully completed in 44 patients, whereas 13 patients underwent modified IPOM converted from TAPP. The surgical results were retrospectively compared. Results: The median follow-up duration was 36.0 months (range, 1-84 months). Intraoperative complications, recurrence of hernia, and chronic pain were not observed in both groups. The average duration of surgery in the modified IPOM group was longer than that in the TAPP group (137 versus 107 minutes, P < .05). There was no significant difference in the incidence of the inguinal-related complications such as inguinal pain or inguinal swelling. Conclusions: Postoperative complications including recurrence of hernia after modified IPOM are comparable to those after TAPP hernia repair. Modified IPOM repair is a surgical option for repairing inguinal hernias following radical prostatectomy.
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Affiliation(s)
- Masakazu Ohuchi
- Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Chiba, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Chiba, Japan
| | - Kunihiko Nagakari
- Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Chiba, Japan
| | - Shintaro Kohama
- Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Chiba, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoichi Ishizaki
- Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, Urayasu-shi, Chiba, Japan
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Tanioka T, Masuko H, Yamagami H, Takahashi S, Ishizu H. Inguinal hernias appearing after lateral lymph node dissection via extraperitoneal approach for advanced lower rectal cancer. Hernia 2019; 23:305-310. [PMID: 30623260 DOI: 10.1007/s10029-019-01881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Lateral lymph node dissection (LLND) is performed for advanced lower rectal cancer (ALRC) in Japan. The LLND in laparotomy is performed via the extraperitoneal approach, which is similar to radical retropubic prostatectomy (RRP). Inguinal hernias (IHs) appearing after RRP are common. However, there are few reports about IHs appearing after LLND. METHODS In part A, we retrospectively investigated 108 patients who underwent LLND for ALRC between January 2004 and December 2014. In part B, we compared 13 patients who underwent IH repair after LLND and 57 patients who underwent IH repair after RRP in the same period. RESULTS In part A, the incidence of IHs after LLND was 7% (8/108). All eight patients who developed IHs were male, and their median age was 60 years. More than 80% of IHs observed were the unilateral lateral type. In part B, the interval between the previous operation and IH occurrence was 4.9 years on average. Furthermore, 2 out of the 13 patients developed additional IHs occurring on the opposite side within 2 years. CONCLUSIONS The characteristics associated with developing IHs after LLND were similar to those after RRP. Any pelvic operation via the extraperitoneal approach has a risk of IHs, and surgeons should pay attention to IHs after surgery.
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Affiliation(s)
- T Tanioka
- Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan.
| | - H Masuko
- Department of Surgery, Nikko Memorial Hospital, Shintomi Cho 1-5-13 Muroran, Hokkaido, 051-8501, Japan
| | - H Yamagami
- Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan
| | - S Takahashi
- Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan
| | - H Ishizu
- Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan
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