title: Nerve-sparing procedure in radical prostatectomy: a risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures.
abstract: OBJECTIVE
  To identify risk factors for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic radical prostatectomy.
  
  
  METHODS
  The medical records of 632 patients who had undergone radical prostatectomy (open retropubic n = 430, pure laparoscopic n = 49, and robot-assisted laparoscopic n = 202) were reviewed retrospectively. Patients with postprostatectomy inguinal hernia were defined as those who had undergone subsequent hernia repair. The mean period of follow-up was 19.5 months (median 19, range 1 to 42).
  
  
  RESULTS
  Hernia repairs were performed in 27 of the 632 patients (4.3%). The site of the repair was right in 15 patients (55.6%), left in 9 patients (33.3%), and bilateral in 3 patients (11.1%). The timing of the hernia repair ranged from 4 to 35 months (mean 13.1) following radical prostatectomy. No difference in hernia-repair-free rates was observed between the extraperitoneal open and transperitoneal pure or robot-assisted laparoscopic radical prostatectomy procedures (p = 0.225, log-rank test). The log-rank test revealed that the nerve sparing procedure (p = 0.019) and the absence of diabetes (p = 0.017) were significant risk factors for postprostatectomy hernia repair. In the multivariate Cox proportional hazards model, neurovascular bundle saving was the only significant risk factor for postprostatectomy inguinal hernia repair (Hazard ratio, 2.64, 95% confidence interval 1.09 to 6.41, p = 0.032).
  
  
  CONCLUSIONS
  These findings suggest that the nerve sparing procedure may increase the risk of hernia repair. Prospective studies are warranted to investigate the possible adverse effects of the nerve sparing technique.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Cho
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
mesh_terms: D000368:Aged; D006552:Hernia, Inguinal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects