Endoscopic extraperitoneal radical prostatectomy in patients with prostate cancer and previous laparoscopic inguinal mesh placement for hernia repair.

Abstract

Since laparoscopic inguinal hernia repair has become a frequently performed surgical procedure, it is inevitable that patients who have been candidates for laparoscopic radical prostatectomy (LRP) may have had such prior intervention. The inguinal hernia repair might take the form of either total extraperitoneal hernioplasty (TEP) or transabdominal extraperitoneal hernioplasty (TAPP), with mesh placement. The objective was to show that performing endoscopic extraperitoneal radical prostatectomy (EERPE) in such patients was safe and feasible, and also to suggest modifications of the technique to facilitate the surgery. There were no specific selection criteria and patients with prior mesh placements were encountered during the management of all consecutive patients undergoing EERPE. Modifications in the port placements were made to accommodate for previous mesh placements on the right and left side. The area of prior mesh placement was excluded from the dissection when creating the extraperitoneal space. The operation was performed, thereafter, using the standard EERPE method. Out of a total of 750 patients operated on with EERPE, 14 had prior TEP or TAPP with mesh placement. In both groups there were no differences found in the mean operative time. There were no major complications or reinterventions in patients with prior mesh placement. In each group (i.e. TEP and TAPP), a small bladder injury was diagnosed and managed intraoperatively with no further complication. One vascular injury to the inferior epigastric vessels was managed intraoperatively without significant blood loss. None of the 14 patients required blood transfusion. The mean catheterization time was 6.9 days. Although certain problems were presented by previous TEP/TAPP, it is nevertheless feasible to perform EERPE. By adapting port placements and surgical techniques the operation can be performed safely and with a good operative outcome.