Abstract
Robotic-assisted radical prostatectomy (RARP) is the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP along with a concomitant hernia repair with mesh is debatable because of the lack of well-designed studies on this subject. Some argue that this procedure may result in mesh infections and increased complications due to possible contact of mesh and urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy. We compared 244 patients (from August 2008 to August 2021) who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) and mesh placement with 244 patients from 6275 RARPs operated on the same period without hernia repair. We performed a propensity score matching analysis using preoperative covariates and compared the perioperative outcomes, and complications in 90 days after surgery. Median follow-up was 36.6 months for the control and hernia groups respectively (p = 0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112 min for the control group and 160 min for hernia groups (p < 0.001). We did not find statistically significant differences in minor complications (Clavien ≤ 2). Although the postoperative readmissions in 90-days were higher in the hernia group (18 vs. 7, p = 0.038), none was associated with mesh complications. Limitation includes the retrospective design of the study. Robotic-assisted radical prostatectomy with simultaneous hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts of an additional surgical procedure.
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The authors listed below have made substantial contributions to the intellectual content of the paper in the various sections described below. Conception and design: TR, CO, and KM; acquisition of data: MCM and SS; analysis and interpretation of data: ARJ, RP and DGL; drafting of the manuscript: ARJ and RP; critical revision of the manuscript for important intellectual content: MCM, ARJ, and VP; statistical analysis: MS; administrative, technical, or material support: SR, and supervision: VP.
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Authors Abdel Rahman Jaber, Marcio Moschovas, Travis Rogers, Shady Saikali, Roshane Perera, Marco Sandri, Shannon Roof, Keila Diaz, Carlos Ortiz and Vipul Patel have no conflict of interest or financial disclosures related to the study.
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Jaber, A.R., Moschovas, M.C., Rogers, T. et al. Simultaneous hernia repair following robotic-assisted radical prostatectomy is safe with low rates of mesh-related complications. J Robotic Surg 17, 1653–1658 (2023). https://doi.org/10.1007/s11701-023-01574-2
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DOI: https://doi.org/10.1007/s11701-023-01574-2