Mourmouris Panagiotis, Argun Omer Burak, Tufek Ilter, Obek Can, Skolarikos Andreas, Tuna Mustafa Bilal, Keskin Selcuk, Kural Ali Riza
1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey .
2 Department of Urology, Cerrahpasa School of Medicine, University of Istanbul , Istanbul, Turkey .
J Endourol. 2016 Feb;30(2):218-22. doi: 10.1089/end.2015.0556. Epub 2015 Nov 17.
To report our experience with concomitant hernia repair during robot-assisted radical prostatectomy (RARP) with a nonprosthetic and tissue-based technique.
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.
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.
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.
报告我们采用非人工合成的组织修补技术在机器人辅助根治性前列腺切除术（RARP）中同期进行疝修补的经验。
我们对2005年至2015年间连续接受RARP的1005例患者进行了回顾性研究。确定了29例患者（第1组），他们同时进行了37次直接腹股沟疝修补术，并与29例未进行疝修补的RARP患者匹配对照组（第2组）进行比较。病例按年龄、体重指数和病理分期1:1匹配。采用改良后壁缝补法加强盆底。修补方法是用连续的普理灵疏松缝线将腹直肌鞘外侧缘缝合至髂耻韧带（库珀韧带）。该技术提供了基于组织的修补，预计通过缝线间继发的纤维组织发育和成熟来实现盆底的最终加强。
在总共1005例接受RARP的患者中，29例（2.8%）术前被诊断为原发性直接腹股沟疝并同期接受了腹股沟疝修补术。第1组手术时间为147分钟，第2组为143分钟（p = 0.8）。疝修补组估计失血量为175 mL，未修补组为200 mL（p = 0.3）。两组均未观察到Clavien-Dindo分级>1的并发症。第1组平均随访期为32.1个月，第2组为33.3个月（p = 0.8）。重要的是，未观察到疝复发。
腹股沟疝是一个重要的外科问题，可在根治性前列腺切除术中同期修补，以尽量降低术后并发症的风险。在机器人根治性前列腺切除术中采用非人工合成材料同期修补腹股沟疝是前列腺切除术中原发性直接疝修补的一种安全可行的替代方法。
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