Outcomes of Minimally Invasive Inguinal Hernia Repair at the Time of Robotic Radical Prostatectomy

  • Francois G. Soto-Palou
  • Ricardo F. Sánchez-Ortiz
Minimally Invasive Surgery (T Guzzo, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Surgery


Abdominal straining associated with voiding dysfunction or constipation has traditionally been associated with the development of abdominal wall hernias. Thus, classic general surgery dictum recommends that any coexistent bladder outlet obstruction should be addressed by the urologist before patients undergo surgical repair of a hernia. While organ-confined prostate cancer is usually not associated with the development of lower urinary tract symptoms, a modest proportion of patients treated with radical prostatectomy may have coexisting benign prostatic hyperplasia with elevated symptom scores and hernias may be incidentally detected at the time of surgery. Furthermore, dissection of the space of Retzius during retropubic or minimally invasive prostatectomy may result exposure of abdominal wall defects which may have been present, but asymptomatic if plugged with preperitoneal fat. Herein we examine the literature regarding the incidence of postoperative inguinal hernias after prostatectomy, review potential risk factors which could aid in preoperative patient identification, and discuss the published experience regarding concurrent hernia repair at the time of open or minimally invasive radical prostatectomy.


Hernia Robotic Prostatectomy 


Compliance with Ethical Standards

Conflict of Interest

Francois G. Soto-Palou and Ricardo F. Sánchez-Ortiz each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Cramer SO, Malangoni MA, Schulte WJ, Condon RE. Inguinal hernia repair before and after prostatic resection. Surgery. 1983;94(4):627–30.PubMedGoogle Scholar
  2. 2.
    Schlegel PN, Walsh PC. The use of the preperitoneal approach for the simultaneous repair of inguinal hernia during surgery on the bladder and prostate. World J Surg. 1989;13(5):555–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Schlegel PN, Walsh PC. Simultaneous preperitoneal hernia repair during radical pelvic surgery. J Urol. 1987;137(6):1180–3.PubMedGoogle Scholar
  4. 4.
    Nielsen ME, Walsh PC. Systematic detection and repair of subclinical inguinal hernias at radical retropubic prostatectomy. Urology. 2005;66(5):1034–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Lepor H, Nieder AM, Ferrandino MN. Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol. 2001;166(5):1729–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Regan TC, Mordkin RM, Constantinople NL, Spence IJ, Dejter Jr SW. Incidence of inguinal hernias following radical retropubic prostatectomy. Urology. 1996;47(4):536–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kyle CC, Hong MK, Challacombe BJ, Costello AJ. Outcomes after concurrent inguinal hernia repair and robotic-assisted radical prostatectomy. J Robot Surg. 2010;4(4):217–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Fukuta F, Hisasue S, Yanase M, et al. Preoperative computed tomography finding predicts for postoperative inguinal hernia: new perspective for radical prostatectomy-related inguinal hernia. Urology. 2006;68(2):267–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982;128(3):492–7.PubMedGoogle Scholar
  10. 10.
    Lodding P, Bergdahl C, Nyberg M, Pileblad E, Stranne J, Hugosson J. Inguinal hernia after radical retropubic prostatectomy for prostate cancer: a study of incidence and risk factors in comparison to no operation and lymphadenectomy. J Urol. 2001;166(3):964–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Nilsson H, Stranne J, Stattin P, Nordin P. Incidence of groin hernia repair after radical prostatectomy: a population-based nationwide study. Ann Surg. 2014;259(6):1223–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Wauschkuhn CA, Schwarz J, Bittner R. Laparoscopic transperitoneal inguinal hernia repair (TAPP) after radical prostatectomy: is it safe? Results of prospectively collected data of more than 200 cases. Surg Endosc. 2009;23(5):973–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Mc DD, Huggins C. Simultaneous prostatectomy and inguinal herniorrhaphy. Surg Gynecol Obstet. 1949;89(5):621.Google Scholar
  14. 14.
    Choi BB, Steckel J, Denoto G, Vaughan ED, Schlegel PN. Preperitoneal prosthetic mesh hernioplasty during radical retropubic prostatectomy. J Urol. 1999;161(3):840–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Teber D, Erdogru T, Zukosky D, Frede T, Rassweiler J. Prosthetic mesh hernioplasty during laparoscopic radical prostatectomy. Urology. 2005;65(6):1173–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee BC, Rodin DM, Shah KK, Dahl DM. Laparoscopic inguinal hernia repair during laparoscopic radical prostatectomy. BJU Int. 2007;99(3):637–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Qazi HA, Rai BP, Do M, et al. Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience. Cent European J Urol. 2015;68(2):240–4.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Lee DK, Montgomery DP, Porter JR. Concurrent transperitoneal repair for incidentally detected inguinal hernias during robotically assisted radical prostatectomy. Urology. 2013;82(6):1320–2.CrossRefPubMedGoogle Scholar
  19. 19.
    Celik O, Akand M, Ekin G, Duman I, Ilbey YO, Erdogru T. Laparoscopic radical prostatectomy alone or with laparoscopic Herniorrhaphy. JSLS. 2015;19(4)Google Scholar
  20. 20.
    Finley DS, Rodriguez Jr E, Ahlering TE. Combined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience. J Urol. 2007;178(4 Pt 1):1296–9. discussion 1299-1300 CrossRefPubMedGoogle Scholar
  21. 21.
    Sanchez-Ortiz RF, Andrade-Geigel C, Lopez-Huertas H, Cadillo-Chavez R, Soto-Aviles O. Preoperative International Prostate Symptom Score Predictive of Inguinal Hernia in Patients Undergoing Robotic Prostatectomy. J Urol. 2015.Google Scholar
  22. 22.
    Junge K, Rosch R, Krones CJ, et al. Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair. Hernia. 2005;9(3):212–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Mourmouris P, Argun OB, Tufek I, et al. Nonprosthetic direct inguinal hernia repair during robotic radical prostatectomy. J Endourol. 2016;30(2):218–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Stolzenburg JU, Rabenalt R, Dietel A, et al. Hernia repair during endoscopic (laparoscopic) radical prostatectomy. J Laparoendosc Adv Surg Tech A. 2003;13(1):27–31.CrossRefPubMedGoogle Scholar
  25. 25.
    Antunes AA, Dall'oglio M, Crippa A, Srougi M. Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach. BJU Int. 2005;96(3):330–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee JY, Diaz RR, Cho KS, Choi YD. Meta-analysis of transperitoneal versus extraperitoneal robot-assisted radical prostatectomy for prostate cancer. J Laparoendosc Adv Surg Tech A. 2013;23(11):919–25.CrossRefPubMedGoogle Scholar
  27. 27.
    Erdogru T, Teber D, Frede T, et al. Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. Eur Urol. 2004;46(3):312–9. discussion 320 CrossRefPubMedGoogle Scholar
  28. 28.
    Bracale U, Melillo P, Pignata G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012;26(12):3355–66.CrossRefPubMedGoogle Scholar
  29. 29.
    Ludwig WW, Sopko NA, Azoury SC, et al. Inguinal hernia repair during Extraperitoneal robot-assisted laparoscopic radical prostatectomy. J Endourol. 2016;30(2):208–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Francois G. Soto-Palou
    • 1
  • Ricardo F. Sánchez-Ortiz
    • 2
  1. 1.Robotic Urology and Oncology Institute and the Division of Urology, Department of SurgeryUniversity of Puerto Rico School of MedicineSan JuanUSA
  2. 2.Robotic Urology and Oncology Institute and the Division of Urology, Department of SurgeryUniversity of Puerto Rico School of Medicine, The University of Texas MD Anderson Cancer CenterSan JuanUSA

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