Frequency of postoperative inguinal hernia after endoscope-assisted mini-laparotomy and conventional retropubic radical prostatectomies

The objective of the present study was to compare the incidence of postoperative inguinal hernia between endoscope-assisted mini-laparotomy retropubic radical prostatectomy (mini-lap RRP) with conventional techniques to identify possible risk factors. From April 1998 to December 2006, 347 consecutive cases with localized prostate cancer were treated with conventional RRP (75 cases) and mini-lap RRP (272 cases) with pelvic lymphadenectomy. Mini-lap RRP was carried out with a 6-cm median incision. The charts were retrospectively reviewed, and the incidence of and risk factors for postoperative inguinal hernia were assessed. There were no significant differences in age, initial prostate-specific antigen concentrations, clinical stage, Gleason score, body mass index, incidence of previous major abdominal surgery (cholecystectomy, gastrectomy, and colectomy), previous appendectomy, and previous inguinal hernia repair between the two groups. Postoperative inguinal hernia was observed in 29 cases (38.7%) in the conventional RRP group and in eight cases (2.9%) in the mini-RRP group during the mean follow-up period of 26.1 months (range: 3-105 months). The patients treated with mini-lap RRP had significantly higher hernia-free survival than those treated with conventional RRP (log rank test, P < 0.001). Multivariate analysis showed that surgical technique (conventional RRP) and previous major abdominal surgery were risk factors for inguinal hernia (P < 0.001 and P = 0.007, respectively). Inguinal hernia was less frequent after mini-lap RRP than after conventional RRP. A history of a major abdominal surgery was an independent risk factor for this event.