title: Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective.
abstract: BACKGROUND
  The laparoscopic approach to repair of inguinal hernia has proven advantages over open repair. Repair of more technically challenging hernias, such as patients previously receiving prostatectomy, has been less studied and may not have these advantages. We aimed to compare safety, feasibility, and clinical outcomes for repairs in patients who previously underwent prostatectomy to control subjects.
  
  
  METHODS
  We undertook a case-control study using a prospectively collected database. From 2004, all patients were routinely offered totally extraperitoneal laparoscopic repair. All patients who had a history of previous prostatectomy were identified and compared to a matched control group. Both operative and follow-up data were analyzed.
  
  
  RESULTS
  Of 987 patients undergoing surgery during this time period, 52 prostatectomy patients were identified (44% open, 44% robotic, 3% laparoscopic) and matched to 102 control subjects. Accounting for bilateral repairs, 203 hernia repairs had been performed. Patients were well matched for age and American Society of Anesthesiologists score. Operative time was longer for prostatectomy patients (mean, 70 vs. 52 min, p < 0.0001); however, this reduced over time when comparing the first and second half prostatectomy patients (77 vs. 63 min, p = 0.144). Overall, there were no intraoperative or major postoperative complications and only one conversion (prostatectomy group). No significant differences were found for rates of minor postoperative complications, length of stay, or recurrence (n = 1, control group). No difference was observed for chronic pain, and all patients in each group reported satisfaction with surgery at contemporary follow-up.
  
  
  CONCLUSIONS
  In experienced hands, totally extraperitoneal inguinal hernia repair for patients previously having undergone prostatectomy is safe and has equivalent outcomes to patients not having undergone prostatectomy, and is an option to open repair. Understandably, slightly longer operative times may be justified, given the benefits of early discharge and less postoperative pain after laparoscopic surgery.
authors.affiliation: Department of UGI Surgery, St Vincent's Hospital, Sydney, NSW, Australia, phillepage@yahoo.com.au.
authors.forename: Philip
authors.initials: P
authors.lastname: Le Page
authors.forename: Ania
authors.initials: A
authors.lastname: Smialkowski
authors.forename: Jonathan
authors.initials: J
authors.lastname: Morton
authors.forename: Douglas
authors.initials: D
authors.lastname: Fenton-Lee
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control; D010537:Peritoneum; D011468:Prostatectomy; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D014945:Wound Healing