title: A novel technique to prevent postradical retropubic prostatectomy inguinal hernia: the processus vaginalis transection method.
abstract: OBJECTIVE
  To present a novel technique to prevent inguinal hernias after radical retropubic prostatectomy (RRP). The incidence of inguinal hernia after RRP has been reported to occur in the range 12%-21%. Indirect hernias are more common than direct hernias after RRP.
  
  
  METHODS
  A total of 569 Japanese patients with prostate cancer underwent antegrade RRP between January 2001 and February 2007. Since February 2006, 138 patients underwent procedures for concurrent inguinal hernia prevention at the time of RRP. For hernia prevention, the processus vaginalis was ligated close to the peritoneal cavity and transected. The remaining 431 patients who underwent the same RRP procedures without hernia prevention were considered control group. The incidence rates of postoperative inguinal hernia in the 2 groups were statistically compared.
  
  
  RESULTS
  An inguinal hernia developed postoperatively in 105 (24%) of the 431 control patients during follow-up of median 42 months. Hernia-free survival rates were 87%, 81%, and 77%, for 1-, 2-, and 3-year, respectively. By contrast, 2 of the 138 patients (1.4%) who underwent hernia prevention developed an inguinal hernia during follow-up of median 24 months. Hernia-free survival rates were both 99% for 1- and 2-year (P <.0001). The hernia prevention procedure added approximately 10 minutes to the surgery time. There were no significant complications associated with the hernia prevention procedure.
  
  
  CONCLUSIONS
  Our results suggest that this prophylactic measure is safe and effective to prevent post-RRP inguinal hernias. However, a longer follow-up period is needed to confirm the results.
authors: Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan. y-fujii.uro@tmd.ac.jp
authors: Yasuhisa
authors: Y
authors: Fujii
authors: Shinya
authors: S
authors: Yamamoto
authors: Junji
authors: J
authors: Yonese
authors: Satoru
authors: S
authors: Kawakami
authors: Yuhei
authors: Y
authors: Okubo
authors: Taisuke
authors: T
authors: Suyama
authors: Yoshinobu
authors: Y
authors: Komai
authors: Toshiki
authors: T
authors: Kijima
authors: Iwao
authors: I
authors: Fukui
mesh_terms: D000368:Aged; D006552:Hernia, Inguinal / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*