title: Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study.
abstract: OBJECTIVE
  To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatectomy (e-RALP) series considering patients with previous laparoscopic inguinal hernia repair (LIHR).
  
  
  METHODS
  We investigated our e-RALP database between March 2008 and August 2014. Age, prostate-specific antigen, prostate volume, and Gleason score were considered as criteria of matched pair analyses. Group 1 consisted of 32 patients who underwent e-RALP with previous LIHR using mesh, and Group 2 consisted of a similar 32 patients without previous LIHR. In addition, preoperative, perioperative, and postoperative data were recorded. Complications were evaluated according to the Clavien-Dindo classification. Significance was P ≤ 0.05.
  
  
  RESULTS
  Mean follow-up was 20.3 ± 3.2 months. In total, 987 patients underwent e-RALP. Preoperative parameters were similar between groups. There were significantly more peritoneum openings, time of anastomosis, trocar placement, preparing Retzius space, pelvic lymph node dissection (PLND), and operative time observed in group 1 than group 2 (respectively, P=0.01, P=0.05, P=0.004, P=0.001, P=0.01, P=0.002). Mean estimated blood loss and time for endopelvic dissection were comparable between groups. In addition, there was no open conversions and pelvic vessel injury. There were, however, two bladder injuries that were treated by using V-loc suture, simultaneously. The most common complication was postoperative fever (Clavien I).
  
  
  CONCLUSIONS
  PLND can be performed safely during e-RALP in patients with previous LIHR. Surgeons should consider careful dissections and possible bladder injury during PLND. Thus, first steps of operation including PLND, could take a longer time in patients with previous LIHR.
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Al-Shareef
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Yigit
authors.initials: Y
authors.lastname: Akin
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Turky
authors.initials: T
authors.lastname: Almouhissen
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Mohammed Saad
authors.initials: MS
authors.lastname: Alshehri
authors.affiliation: 1 Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany .
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Gözen
authors.affiliation: 2 Department of Urology, University Hospital of Heidelberg , Heidelberg, Germany .
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D061646:Operative Time; D010388:Pelvis / Q000601:surgery; D010537:Peritoneum / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen