Introduction and objective
Robotic-assisted radical prostatectomy (RARP) is known as the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP concomitant with hernia repair with mesh is debatable, as the current literature is not supported by well-designed or sufficient studies. Some argue that this procedure may result in mesh infections due to possible contact with urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy.
Methods
From August 2008 to August 2021, we prospectively collected the data of 244 patients who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) with mesh placement. After a propensity score match (PS), these patients were retrospectively compared with with 244 patients from 6275 RARPs operated on during the same period without hernia repair. We report the preoperative demography and perioperative outcomes up to 90 days after the surgery.
Results
Median follow-up was 36.6 months for the control and hernia groups, respectively (p=0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112 min for the control group and 160 min for the hernia groups (p<0.001). Estimated median blood loss was 100mL and 50mL for the control and hernia groups, respectively (p=0.41). We did not find statistically significant differences in minor complications (Clavien≤2). Although the postoperative readmissions within 90-days were higher in the hernia group (18 vs.7, p=0.038), none were associated with mesh complications.
Conclusions
Robotic-assisted radical prostatectomy with concomitant hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts related to an additional surgical procedure.