title: Impact of previous inguinal hernia repair on transperitoneal robotic prostatectomy.
abstract: OBJECTIVE
  Several investigators have noted that previous inguinal hernia repair with or without the use of prosthetic mesh might be a relative contraindication for open or laparoscopic radical prostatectomy due to the presence of adhesions and the difficulty of tissue dissection. We aimed to evaluate the impact of previous hernia repair on the performance and feasibility of robotic prostatectomy.
  
  
  METHODS
  We performed a retrospective analysis of 354 patients who underwent robotic prostatectomy at our institution. The three patient groups were: 292 patients who had no prior hernia repair (group 1), 50 patients who had prior inguinal herniorrhaphy without the use of prosthetic mesh (group 2), and 12 patients who had prior inguinal herniorrhaphy with the use of prosthetic mesh. We compared operative time (surgeon console time), estimated blood loss, and operative complications (bladder, bowel, and/or vascular injuries) in the three groups.
  
  
  RESULTS
  Patients with no prior herniorrhaphy (group 1), prior herniorrhaphy without mesh (group 2), and prior herniorrhaphy with mesh (group 3), had similar mean operating times (126.9 minutes, 129.3 minutes and 145.6 minutes, respectively) and similar mean estimated blood loss (152.5 ml, 140.6 ml, and 141.6 ml, respectively) during radical prostatectomy. However, compared to the group of patients who had no prior hernia repair, the group who had prior herniorrhaphy with the use of mesh had a significantly longer mean console operating time (145.6 versus 126.9 minutes, p = .012).
  
  
  CONCLUSIONS
  Previous hernia surgery, with or without the use of prosthetic mesh, did not represent a significant barrier to the performance of transperitoneal robotic prostatectomy.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA.
authors.forename: Rajesh G
authors.initials: RG
authors.lastname: Laungani
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Fred
authors.initials: F
authors.lastname: Muhletaler
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D005240:Feasibility Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D013526:Surgical Mesh