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Influence of previous laparo-endoscopic inguinal hernia repair on performing radical prostatectomy: a nationwide survey among urological surgeons

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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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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands

    Wouter J. Bakker, Marleen M. Roos & Josephina P. J. Burgmans

  2. Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands

    Richard P. Meijer

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  1. Wouter J. Bakker
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  2. Marleen M. Roos
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  3. Richard P. Meijer
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  4. Josephina P. J. Burgmans
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Contributions

WB—study conception and design, data collection, analysis and interpretation of data, drafting of manuscript. MR—study conception and design, data collection, critical revision. RM—study conception and design, critical revision. JB—study conception and design, interpretation of data, critical revision.

Corresponding author

Correspondence to Wouter J. Bakker.

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Wouter J. Bakker, Marleen M. Roos, Richard P. Meijer and Josephina P. J. Burgmans declare that they have no conflict of interests or financial ties to disclose.

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All procedures performed in this study did not involve human or animal participants.

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Bakker, W.J., Roos, M.M., Meijer, R.P. et al. Influence of previous laparo-endoscopic inguinal hernia repair on performing radical prostatectomy: a nationwide survey among urological surgeons. Surg Endosc 35, 2583–2591 (2021). https://doi.org/10.1007/s00464-020-07676-4

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