The Department of Surgery, The University of Tokushima, Tokushima, Japan.
Asian J Endosc Surg. 2022 Jan;15(1):155-161. doi: 10.1111/ases.12985. Epub 2021 Sep 12.
Robot-assisted radical prostatectomy (RARP) is nowadays being performed worldwide, and inguinal hernia (IH) continues to be a common complication of radical prostatectomy. Laparoscopic repair of IH is often difficult via internal dissection because of adhesion of the preperitoneal cavity. This study aimed to categorize the intraoperative condition of, and devise a strategy for, IH after RARP.
Of 577 patients who underwent RARP, 18 developed IH. These 18 patients then underwent laparoscopic IH repair using the transabdominal preperitoneal approach (TAPP) or modified intraperitoneal onlay mesh repair (mIPOM). Internal dissection was categorized into two groups according to the appearance of Cooper's ligament (exposed or not exposed).
After RARP, four patients had exposure of Cooper's ligament while 14 patients showed no exposure. Both patients in the exposed group underwent TAPP and all patients in the not-exposed group underwent mIPOM. There was no significant difference between normal TAPP and RARP regarding operative factors, and IH recurrence was not observed.
Laparoscopic repair of IH after RARP is rendered safe and efficient by using our categorization based on the exposure of Cooper's ligament and extension of preperitoneal space.
机器人辅助根治性前列腺切除术（RARP）如今在全球范围内进行，而腹股沟疝（IH）仍然是根治性前列腺切除术的常见并发症。由于腹膜前腔的粘连，经内部解剖进行腹腔镜 IH 修复通常很困难。本研究旨在对 RARP 后 IH 的术中情况进行分类，并制定相应的治疗策略。
在接受 RARP 的 577 例患者中，有 18 例发生 IH。这 18 例患者随后采用经腹腹膜前途径（TAPP）或改良腹腔内上置网片修补术（mIPOM）进行腹腔镜 IH 修补。根据 Cooper 韧带（暴露或未暴露）的外观将内部解剖分为两组。
在 RARP 后，4 例患者的 Cooper 韧带暴露，14 例患者的 Cooper 韧带未暴露。暴露组的 2 例患者均接受 TAPP，未暴露组的 14 例患者均接受 mIPOM。正常 TAPP 和 RARP 在手术因素方面无显著差异，且未观察到 IH 复发。
根据 Cooper 韧带的暴露情况和腹膜前间隙的扩展情况对 RARP 后 IH 进行分类，可使腹腔镜修复 IH 既安全又有效。
