Departments of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan. Departments of Urology, Kanazawa University, Kanazawa, Japan.
Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.
Acquired Inguinal Hernia, Laparoscopic Hernioplasty, Robotic-Assisted Laparoscopic Prostatectomy
Kawaguchi, M. , Kadono, Y. , Shimada, M. , Moriyama, H. , Ishikawa, N. and Watanabe, G. (2014) Laparoscopic Observations in Acquired Inguinal Hernia before and after Robotic-Assisted Laparoscopic Prostatectomy. Surgical Science, 5, 170-175. doi: 10.4236/ss.2014.54030.
[1] Van Wessem, K.J.P., Simons, M.P. and Lange, J.F. (2003) The Etiology of Indirect Inguinal Hernias: Congenital and/or Acquired? Hernia, 7, 76-79. http://dx.doi.org/10.1007/s10029-002-0108-7
[2] Abrahamson, J. (1998) Etiology and Pathophysiology of Primary and Recurrent Groin Hernia Formation. Surgical Clinics of North America, 78, 953-972. http://dx.doi.org/10.1016/S0039-6109 (05)70364-9
[3] Zhu, S., Zhang, H., Xie, L., Chen, J. and Niu, Y. (2013) Risk Factors and Prevention of Inguinal Hernia after Radical Pros-Tatectomy: A Systematic Review and Meta-Analysis. Journal of Urology, 189, 884-890.http://dx.doi.org/10.1016/j.juro.2012.08.241
[4] Kawaguchi, M., Ishikawa, N., Nishida, Y., Moriyama, H., Kaneki, M., and Watanabe, G. (2012) Laparoscopic Hernioplasty Using Omega-3 Coating Mesh. Surgical Science, 3, 389-392.
http://dx.doi.org/10.4236/ss.2012.38077
[5] Miserez, M., Alexandre, J.H., Campanelli, G., Corcione, F., Cuccurullo, D., Pascual, M.H., et al. (2007) The European Hernia Society Groin Hernia Classification: Simple and Easy to Remember. Hernia, 11, 113-116.http://dx.doi.org/10.1007/s10029-007-0198-3
[6] Lee, D.H., Jung, H.B., Chung, M.S. and Chung, B.H. (2013) Patent Processus Vaginalis in Adults Who Underwent Robot-Assisted Laparoscopic Radical Prostatectomy: Predictive Signs of Postoperative Inguinal Hernia in the Internal Inguinal Floor. International Journal of Urology, 20, 177-182. http://dx.doi.org/10.1111/j.1442-2042.2012.03118.x
[7] van Veen, R.N., van Wessem, K.J.P., Halm, J.A., Simons, M.P., Plaisier, P.W., Jeekel, J., et al. (2007) Patent Processus Vaginalis in the Adult as a Risk Factor for the Occurrence of Indirect Inguinal Hernia. Surgical Endoscopy, 21, 202-205. http://dx.doi.org/10.1007/s00464-006-0012-9
[8] Lytle, W.J. (1945) The Internal Inguinal Ring. British Journal of Surgery, 32, 441-446.
http://dx.doi.org/10.1002/bjs.18003212802
[9] Mirilas, P., Colborn, G.L., McClusky III, D.A., Skandalakis, L.J., Skandalakis, P.N. and Skandalakis, J.E. (2005) The History of Anatomy and Surgery of the Preperitoneal Space. Archives of Surgery, 140, 90-94.http://dx.doi.org/10.1001/archsurg.140.1.90
[10] Kanaya, S., Tamaki, N., Momoi, H., Gomi, T., Katayama, T., Wada, Y., et al. (2002) Layered Structures of Fascia in the Inguinal Region. Rinsho Geka, 57, 1027-1032.
[11] Sakurai, S. (2001) Tension-Free Hernioplasty. Geka Chiryou, 84, 393-404.
[12] Carilli, S., Alper, A. and Emre, A. (2004) Inguinal Cord Lipomas. Hernia, 8, 252-254.
http://dx.doi.org/10.1007/s10029-004-0231-8
[13] Taguchi, K., Yasui, T., Kubota, H., Fukuta, K., Kobayashi, D., Naruyama, H., et al. (2010) Simple Method of Preventing Postoperative Inguinal Hernia after Radical Retropubic Prostatectomy. Urology, 76, 1083-1087.http://dx.doi.org/10.1016/j.urology.2010.05.002
[14] Fujii, Y., Yamamoto, S., Yonese, J., Kawakami, S., Okubo, Y., Suyama, T., et al. (2010) A Novel Technique to Prevent Postradical Retropubic Prostatectomy Inguinal Hernia: The Processus Vaginalis Transection Method. Urology, 75, 713-717. http://dx.doi.org/10.1016/ j.urology.2009.05.051
[15] Stranne, J., Aus, G., Bergdahl, S., Damber, J.-E., Hugosson, J., Khatami, A., et al. (2010) Post-Radical Prostatectomy Inguinal Hernia: A Simple Surgical Intervention Can Substantially Reduce the Incidence—Results from a Prospective Randomized Trial. The Journal of Urology, 184. 984-989. http://dx.doi.org/10.1016/j.juro.2010.04.067