Is previous radical prostatectomy an adversity for laparoscopic total extraperitoneal approach for inguinal hernia repair? A propensity score case matched study.

INTRODUCTION

Although laparoscopic total extraperitoneal (TEP) procedure has gained wide acceptance for inguinal hernia repair, there is still debate on the optimal technique in patients with a history of previous radical prostatectomy (RP). We aimed to evaluate the feasibility and safety of laparoscopic TEP in patients with a previous history of RP using a propensity score case-match analysis.

METHODS

This study included male patients undergoing laparoscopic TEP repair between 2013 and 2024. According to the RP status, patients were case-matched based on age, BMI, ASA score, site of hernia and the year of surgery. A total of 162 patients were matched in a 1:5 ratio. The RP and non-RP groups were compared with respect to perioperative outcomes.

RESULTS

The RP and non-RP group included 27 and 135 patients, respectively. The rate ofconversion to transabdominal preperitoneal repair (11.1%) or open surgery (14.8%) was significantly higher in the RP group (p<0.001). The RP group had longer operative times (160±57 vs. 94±38, p<0.001). The postoperative complication rates (7.4% vs. 6%), postoperative pain scores, length of stay (1.6±0.9 vs 1.2±0.9 days), time to return to daily life (2.9±1.8 vs 2.6±3.0 days), readmission (3.7% vs 0.7%), long-lasting pain (14.8% vs. 11.8%) and recurrence (0% vs 3.2%) were similar in both groups (p>0.05).

CONCLUSION

Laparoscopic TEP inguinal hernia repair in patients with a history of RP is feasible and safe with a similar morbidity profile but an increased conversion rate and operative time compared to those with no history of RP.