Simple Method of Preventing Postoperative Inguinal Hernia After Radical Retropubic Prostatectomy
published online 13 July 2010. Corrected Proof
Objectives
To establish a novel and simple method of preventing post-retropubic prostatectomy (RRP) inguinal hernia. Inguinal hernias occur in 8%-22% of men within 1-2 years of RRP. Although manipulation during RRP might weaken the normal fascia structure at the internal inguinal ring with the vas deferens, the exact mechanism of post-RRP inguinal hernia remains unknown.
Methods
Several surgeons performed RRP at our hospital on 271 patients between April 2004 and September 2009. Among these patients, post-RRP measures to prevent inguinal hernia were applied to 101 patients (group A) and not applied to 170 patients (group B). We released the bilateral spermatic cord from the peritoneum before suturing the wound, which should prevent the intestinal tract coated with the peritoneum from pushing through the internal inguinal tract. We compared the incidence of postoperative inguinal hernia between the 2 groups.
Results
The patients were followed up for an average of 11.6 (range: 2-22 months) and 23.9 (range: 23-24 months) months in groups A and B, respectively. Inguinal hernia developed in no patients in group A and in 20 (11.8%) in group B. The hernia-free rate was significantly lower in group B than group A. All postoperative inguinal hernias were indirect. The median interval between surgery and hernia diagnosis was 10.6 months (range, 2-24), and 16 patients (80%) were diagnosed within 12 months.
Conclusions
We developed a simple method of preventing inguinal hernia after RRP. Our technique is simple enough to complete within a few minutes, and the outcome is excellent.
aDepartment of Urology, Kainan Hospital Aichi, Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
bDepartment of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Reprint requests: Takahiro Yasui, M.D., Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
ABSTRACT