Department of Surgery, Maria Middelares, Ghent, Belgium.
Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.
Surg Endosc. 2022 Mar;36(3):2105-2112. doi: 10.1007/s00464-021-08497-9. Epub 2021 Apr 1.
Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during minimally invasive inguinal hernia repair. Therefore, it suggested that an open anterior technique should be used rather than a minimally invasive posterior technique in these patients.
In this single-center study, a retrospective analysis of a prospectively maintained database was performed. All patients undergoing inguinal hernia repair after previous transabdominal prostatectomy were included in this analysis, and the feasibility, safety, and short-term outcomes of open and robotic-assisted laparoscopic inguinal hernia repair were compared.
From 907 inguinal hernia operations performed between March 2015 and March 2020, 45 patients met the inclusion criteria. As the number of patients treated with conventional laparoscopy was very low (n = 2), their data were excluded from statistical analysis. An open anterior repair with mesh (Lichtenstein) was performed in 21 patients and a robotic-assisted laparoscopic posterior transabdominal repair (rTAPP) in 22. Patient characteristics between groups were comparable. A transurethral urinary catheter was placed during surgery in 17 patients, most often in the laparoscopic cases (15/22, 68.2%). In the rTAPP group, a higher proportion of patients was treated for a bilateral inguinal hernia (50%, vs 19% in the Lichtenstein group). There were no intraoperative complications and no conversions from laparoscopy to open surgery. No statistically significant differences between both groups were observed in the outcome parameters. At 4 weeks follow-up, more patients who underwent rTAPP had an asymptomatic seroma (22.7% vs 5% in the Lichtenstein group) and two patients were treated postoperatively for a urinary tract infection (4.7%).
A robotic-assisted laparoscopic approach to inguinal hernia after previous transabdominal prostatectomy seems safe and feasible and might offer specific advantages in the treatment of bilateral inguinal hernia repairs.
经腹前列腺切除术会导致耻骨后空间的疤痕形成，这可能会使微创腹股沟疝修补术中的腹膜前解剖和网片放置复杂化。因此，建议在这些患者中使用开放式前入路技术而不是微创后入路技术。
在这项单中心研究中，对一个前瞻性维护的数据库进行了回顾性分析。所有在经腹前列腺切除术后接受腹股沟疝修补术的患者均纳入本分析，并比较了开放式和机器人辅助腹腔镜腹股沟疝修补术的可行性、安全性和短期结果。
在 2015 年 3 月至 2020 年 3 月期间进行的 907 例腹股沟疝手术中，有 45 例符合纳入标准。由于接受传统腹腔镜治疗的患者数量非常少（n=2），因此其数据未纳入统计分析。21 例患者行开放式前入路修补术（Lichtenstein 法），22 例行机器人辅助腹腔镜后入路修补术（rTAPP）。两组患者的特征相似。17 例患者在手术中留置了经尿道导尿管，最常见于腹腔镜组（15/22，68.2%）。在 rTAPP 组中，更多的患者为双侧腹股沟疝（50%，Lichtenstein 组为 19%）。两组在术中并发症和腹腔镜转为开放手术方面均无差异。两组在术后结果参数方面无统计学差异。在 4 周随访时，更多接受 rTAPP 治疗的患者出现无症状性血清肿（22.7%，Lichtenstein 组为 5%），有两名患者术后因尿路感染而接受治疗（4.7%）。
经腹前列腺切除术后继发腹股沟疝的机器人辅助腹腔镜入路似乎是安全可行的，并且在治疗双侧腹股沟疝修补术方面可能具有特定的优势。
