Laparoscopic inguinal hernia repair after prostatectomy: Evaluating safety, efficacy, and efficiency

Laparoscopic inguinal hernia repair after prostatectomy: Evaluating safety, efficacy, and efficiency

For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients. This is a review of a prospectively collected hernia databas...

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Bibliographic Details
Published in:Surgery Vol. 166; no. 4; pp. 607 - 614
Main Authors: Callahan, Zachary M., Donovan, Kara, Su, Bailey S., Kuchta, Kristine, Carbray, JoAnn, Linn, John G., Denham, Woody, Haggerty, Stephen P., Joehl, Raymond J., Ujiki, Michael B.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2019
Subjects:
Adult
Aged
Cohort Studies
Databases, Factual
Hernia, Inguinal - diagnosis
Hernia, Inguinal - surgery
Herniorrhaphy - methods
Humans
Laparoscopy - methods
Laparotomy - methods
Male
Middle Aged
Patient Safety
Prognosis
Prostatectomy - methods
Recovery of Function
Retrospective Studies
Risk Assessment
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Summary:For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients. This is a review of a prospectively collected hernia database evaluating patients who underwent totally extraperitoneal repair between October 2009 and March 2018. Patients with prior prostatectomy were matched to controls without prior prostatectomy. Secondary analysis compared the case group to patients who underwent open hernia repair. In the study, 1,751 patients underwent laparoscopic totally extraperitoneal repair. Thirty patients with a prior prostatectomy were matched to 90 controls. Operative duration was greater in the prostatectomy group (56 vs 36 minutes, P < .0001) and more peritoneal tears occurred (40% vs 12%, P = .002). Duration of stay, return to activity, complications, and rates of recurrence and chronic pain were equivalent. When compared with prior prostatectomy patients who underwent open hernia repair, the laparoscopic totally extraperitoneal group had equivalent rates of complications and outcomes with a faster return to activities of daily living (3 vs 7 days P = .007). Despite a more difficult dissection, laparoscopic totally extraperitoneal repair in patients with prior prostatectomy is safe, efficacious, and efficient. In addition, totally extraperitoneal offers similar outcomes to open repair with a quicker recovery in this patient population.
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ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2019.04.041