Prevention of inguinal hernias after radical prostatectomy

As regular readers will be aware, inguinal hernias are a well-known complication following a radical radical retropubic prostatectomy (RRP). A Japanese surgical team has now reported a method that seems to significantly reduce risk of this complication.

According to a paper by in Koike et al. in Prostate International their solution is one that “any surgeon can complete within a few minutes.” The procedure involves a relatively minor surgical modification in which the surgeon “released approximately 5 cm of the bilateral vas deferens and spermatic vessels from the peritoneum.” Koike et al. also note that, “In cases in which the processus vaginalis had spread into the abdomen, we ligated it close to the peritoneal cavity and then transected it.”

In their paper, Koike et al. report on outcomes data from a series of 230 Japanese men who received an RRP between  January 2007 and September 2011. Between July 2009 and September 2011, 115 patients underwent the additional inguinal hernia prevention procedure described above. The  other 115 patients underwent RRP but did not have the hernia prevention procedure. They could therefore be used as the control group.

The authors report the following outcomes:

  • Among the 115 men in the control group
    • 18/115 patients (15.7 percent) developed inguinal hernias in the follow-up period.
    • The hernia-free survival rate was 89.6% at 1 year and 84.1 percent at 2 years post-surgery.
  • Among the 115 men who received the hernia prevention procedure
    • The average (median) follow-up was 27 months
    • 1/115 patients (0.9 percent) developed an inguinal hernia during the follow-up period.
    • The hernia-free survival rate of this group was 100 percent at 1 and 2 years post-surgery.

Clearly this represents a major reduction in risk for inguinal hernia post-surgery.

It would be interesting to know what other experienced surgeons think about this new report and whether other surgical teams were already aware of the technique described bu Koike et al. or have been using similar techniques to limit risk for inguinal hernia.

3 Responses

  1. Funny. In the sense that I don’t think I’ve ever heard of a prostatectomy patient who developed a hernia of any kind.

  2. Dear Dr. Krongrad:

    It really is a relatively common event post-surgery, although I am not sure I could give you an accurate risk rate.

  3. One of my in-person prostate cancer support groups includes two men who developed inguinal hernia after radical prostatectomy (out of about eight or ten), and one of my online groups includes at least half a dozen (out of about 200).

    If Dr. Krongrad has not encountered this, I have to assume the RPs that he performs include bolstering that many other surgeons fail to do.

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