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Surgical technique and outcomes of transabdominal preperitoneal inguinal hernia repair after radical prostatectomy: dissection between the transversalis fascia and superficial layers of preperitoneal fascia

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Abstract

Purpose

The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases.

Methods and materials

From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes.

Results

The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients.

Conclusion

In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan

    Masakazu Ohuchi, Masaki Fukunaga, Kunihiko Nagakari, Daisuke Azuma, Shintaro Kohama & Jun Nomoto

  2. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 3-1-3 Hongou Bukyo-ku, Tokyo, 113-8431, Japan

    Kazuhiro Sakamoto

Authors
  1. Masakazu Ohuchi
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  2. Masaki Fukunaga
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  3. Kunihiko Nagakari
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  4. Daisuke Azuma
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  5. Shintaro Kohama
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  6. Jun Nomoto
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  7. Kazuhiro Sakamoto
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Corresponding author

Correspondence to Masakazu Ohuchi.

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Conflict of interest

Masakazu Ohuchi, Masaki Fukunaga, Kunihiko Nagakari, Daisuke Azuma, Shintaro Kohama, Jun Nomoto, and Kazuhiro Sakamoto declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and abided with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all patients included in the study.

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Ohuchi, M., Fukunaga, M., Nagakari, K. et al. Surgical technique and outcomes of transabdominal preperitoneal inguinal hernia repair after radical prostatectomy: dissection between the transversalis fascia and superficial layers of preperitoneal fascia. Hernia 23, 167–174 (2019). https://doi.org/10.1007/s10029-018-1800-6

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  • DOI: https://doi.org/10.1007/s10029-018-1800-6

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