title: Post-radical prostatectomy inguinal hernia: a simple surgical intervention can substantially reduce the incidence--results from a prospective randomized trial.
abstract: OBJECTIVE
  After radical retropubic prostatectomy a postoperative inguinal hernia develops in 15% to 20% of patients. We investigated whether a simple prophylactic procedure during radical retropubic prostatectomy would reduce this incidence.
  
  
  METHODS
  A total of 294 consecutive patients scheduled for radical retropubic prostatectomy at our clinic were prospectively included in the study. Patients with a present inguinal hernia or a previous inguinal hernia surgery were not included in the analysis. The subjects were randomized for side of prophylactic intervention (left or right). At radical retropubic prostatectomy a nonresorbable figure-of-8 suture was placed lateral to the internal ring of the inguinal canal and the spermatic cord on either side according to outcome of the randomization. Patients were followed at regular followup visits at the clinic. At the end of the study all patients were invited for a final interview and examination by an independent examiner who was unaware of the side of intervention.
  
  
  RESULTS
  Of the patients 86% (254) showed up for the final examination. The cumulative inguinal hernia incidence was 3.5% on the intervention side and 9.1% on the control side (log rank Mantel-Cox p = 0.011). There were no serious adverse events, and no increase in postoperative discomfort in the groin and testicular region on the intervention side. The procedure added 5 to 10 minutes to the duration of surgery.
  
  
  CONCLUSIONS
  The prophylactic procedure was simple and safe to perform, and it decreased the risk of postoperative inguinal hernia formation by 62%. We believe it should be considered for patients undergoing radical retropubic prostatectomy.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. johan.stranne@vgregion.se
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Svante
authors.initials: S
authors.lastname: Bergdahl
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Damber
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Ali
authors.initials: A
authors.lastname: Khatami
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D006552:Hernia, Inguinal / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*