Effects of previous hernia repair on extraperitoneal robot-assisted radical prostatectomy: A matched-pair analysis study

Abstract

Purpose: 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). Conclusion: 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.