A Simple Procedure to Prevent Postoperative Inguinal Hernia after Robot-Assisted Laparoscopic Radical Prostatectomy: A Plugging Method of the Internal Inguinal Floor for Patients with Patent Processus Vaginalis

Purpose: We introduce a simple procedure to prevent postoperative inguinal hernia after robot-assisted laparoscopic radical prostatectomy. We developed the inguinal hernia prevention procedure based on our prior study. Patent processus vaginalis is an independent predictor of inguinal hernia after robot-assisted laparoscopic radical prostatectomy. Materials and Methods: We reviewed 74 patients (98 groins) with patent processus vaginalis during robot-assisted laparoscopic radical prostatectomy between May 2007 and April 2013. Of these patients 38 (47 groins) did not undergo the inguinal hernia prevention procedure and 36 (51 groins) were treated with this procedure. For the inguinal hernia prevention the lateral side internal inguinal floor of the patent processus vaginalis was incised and dissected along the spermatic cord. Hemostatic agents were plugged into the end of the dissected canal. After plugging, the internal inguinal floor was closed. We compared the incidence of postoperative inguinal hernia between the 2 groups. Results: Among the 47 groins of the patients who did not undergo the inguinal hernia prevention procedure, postoperative inguinal hernia occurred in 16 groins (34.0%) and developed by a mean of 13.8 +/- 8.5 months. In contrast, none of the patients who underwent the inguinal hernia prevention procedure experienced postoperative inguinal hernia during the followup of 11.8 +/- 6.2 months. This inguinal hernia prevention procedure required approximately 3 extra minutes. During followup there were no intraoperative or postoperative complications related to the inguinal hernia prevention procedure. Conclusions: Using our simple inguinal hernia prevention procedure, the preventive effect was remarkable. However, studies in a larger patient population with a longer followup should be performed to prove the ultimate clinical impact of this inguinal hernia prevention procedure.