Nonprosthetic Direct Inguinal Hernia Repair During Robotic Radical Prostatectomy.
OBJECTIVE
To report our experience with concomitant hernia repair during robot-assisted radical prostatectomy (RARP) with a nonprosthetic and tissue-based technique.


METHODS
We conducted a retrospective review on 1005 consecutive patients who underwent RARP between the years 2005 and 2015. Twenty-nine patients, who underwent 37, concurrent, direct, inguinal hernia repairs, were identified (group 1) and compared to a match control group of 29 patients who underwent RARP without hernia repair (group 2). Cases were matched 1:1 for age, body-mass index, and pathologic stage. The reinforcement of the floor was achieved with a modified posterior wall darn repair. The repair consisted of suturing the lateral edge of the rectus abdominis muscle sheath to the ileopectineal ligament (Cooper's ligament) with continuous prolene loose suture. This technique provided a tissue-based repair and the final reinforcement of the floor was expected to ensue by the secondary fibrotic tissue development and maturing between the sutures.


RESULTS
From a total of 1005 patients who underwent RARP, 29 (2.8%) were preoperatively identified with a primary, direct inguinal hernia and underwent concomitant inguinal herniorrhaphy. The operative time was 147 minutes for group 1 vs 143 minutes for group 2 (p = 0.8). Estimated blood loss was 175 mL for the group with the hernia repair vs 200 mL for the group without repair (p = 0.3). There were no Clavien-Dindo grade >1 complications observed in either of the groups. Mean follow-up period was 32.1 months for group 1 vs 33.3 for group 2 (p = 0.8). Importantly, no hernia recurrences were observed.


CONCLUSIONS
Inguinal hernias represent an important surgical issue and may be repaired concurrently during radical prostatectomy to minimize the risks of postoperative complications. The concomitant repair of inguinal hernias during robotic radical prostatectomy utilizing a nonprosthetic is a safe and feasible alternative for primary direct hernia repair during prostatectomy.
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
Panagiotis
P
Mourmouris
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
Omer Burak
OB
Argun
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
Ilter
I
Tufek
2 Department of Urology, Cerrahpasa School of Medicine, University of Istanbul , Istanbul, Turkey .
Can
C
Obek
3 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens , Athens, Greece .
Andreas
A
Skolarikos
4 Department of Urology, Aile Hospital , Istanbul, Turkey .
Mustafa Bilal
MB
Tuna
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
Selcuk
S
Keskin
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
Ali Riza
AR
Kural
D000368:Aged; D015897:Comorbidity; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*