Best Practices & Benign Disease
Introduction & Objective : Robotic assisted laparoscopic prostatectomy (RALP) is the current standard of care for the surgical management of prostate cancer. Inguinal and ventral hernias is a well known post operative complication, and incidence in the literature ranges from 7-21%.1 Arguably, some patients might have missed/undiagnosed hernias preoperatively that may become symptomatic post operatively. Studies have shown feasibility in concurrent hernia repair at time of RALP without a significant increase in complications, length of hospital stay (LOS) or need for reoperation.2 The objective of our study was to analyze our database of patients who underwent concurrent RALP with hernia repairs.
Methods : This was a retrospective chart review of patients who underwent concurrent RALP with inguinal or ventral hernia repairs at our institution between 2007 through 2016. The control group comprised randomly selected patients who underwent RALP alone during the same time period by the same surgeons. Primary outcomes were overall complications, recurrence rate, and LOS.
There was a total of 51 patients who underwent concurrent RALP with hernia repair between 2007 through 2016 at our institution. Majority of patients had either one inguinal or umbilical hernia, but some had bilateral hernias or an umbilical and unilateral inguinal hernia. In total 32 inguinal and 24 umbilical hernias were repaired. There was no difference in mean age or BMI between the hernia group versus control, 60.2 vs. 60.0 years and 29.7 vs. 29.9, respectively. No hernia recurrence was recorded in the study group. No difference was found in LOS (1.35 vs. 1.09, p=0.122). One patient in the hernia group was taken back to the OR a week later due to a partial small bowel obstruction for a negative diagnostic laparoscopy.
Conclusions : Our data shows that concurrent RALP with hernia repair is safe, effective, and not associated with increased LOS or complications. Men should be evaluated preoperatively for hernias and if present, should be offered the option of concurrent repair.