S&T-26 COMBINED INGUINAL HERNIA REPAIR WITH A SYNTHETIC MESH DURING ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: About 10 % of patients undergoing radical prostatectomy (RP) present with an inguinal hernia. Its cure simultaneously with RP remains a concern with respect to the type of technique, and the risk to infect an eventual mesh The aim of this study was to evaluate the feasability, morbidity and efficacy of combined inguinal hernia synthetic mesh repair during robot assisted radical prostatectomy (RARP). METHODS: 526 medical records of patients who underwent transperitoneal RARP from 2006 to 2015 were reviewed. Demographics and peri-operative datas were analyzed for two groups (RARP alone vs RARP and hernia repair). Pre-operative iv cefazoline and gentamycine was given to all patients. Cure was performed using a polyester mesh (Parietex Covidien, New Haven, USA), placing the porous side against the wall for an efficient tissue integration, and the smooth side facing the structures on which tissular attachment had to be limited. The mesh was cut in a rectangle of approximately 10x8 cm or 18x8 cm for respectively unilateral and bilateral cures, and was anchored with absorbable staples (Absorbatack e Covidien), so as non absorbable sutures around the iliac vessels. Early complications were classified using ClavienDindo classification. Hernia recurrence was assessed during regular follow-up, or self-reported by patients. RESULTS: 49 patients (9 %) had a hernia repair associated with RARP (35 unilateral and 14 bilateral). Median age, BMI and ASA score were the same in both groups. Total operative time was 278 min for RARP vs 290 min for combined procedure. Post-operative length of stay (median 4 days) and blood loss were not affected by the combined procedure. There were no mesh infections nor migrations. Complication rate was identical in both groups. After a median follow-up of 44 months (IQR 17-86), 46 patients (94 %) were hernia-free, while 3 (6 %) presented a hernia recurrence. CONCLUSIONS: Combined inguinal hernia repair with a synthetic mesh during RARP is a feasible and efficient procedure which added no morbidity to standard RARP. Placing the mesh during an operation with urine spillage led to no infections. Efficacy after medianterm follow-up is similar to laparoscopic hernia repair alone. Combined hernia repair should therefore be discussed for patients undergoing RARP suffering from inguinal hernia.