What lies beneath – No need to fear a minimally invasive approach to inguinal hernia repairs after prior low abdominal surgery

Abstract

Inguinal hernia repair (IHR) is one of the most commonly performed surgeries by general surgeons. Prior pelvic or low abdominal surgery has been previously considered by many surgeons to be a contraindication to minimally invasive IHR due to the scar tissue formed in the operative space, which may create an increased level of difficulty and an added potential risk for complications. 1 Angus A. DeMare A. Iacco A. Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database. Surg Endosc. 2021; 35 ([doi]): 5310-5314https://doi.org/10.1007/s00464-020-08020-6 Crossref PubMed Scopus (6) Google Scholar However, many recent studies have demonstrated that repair with minimally invasive techniques can be safe in patients who have undergone prior pelvic or low abdominal surgery. 1 Angus A. DeMare A. Iacco A. Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database. Surg Endosc. 2021; 35 ([doi]): 5310-5314https://doi.org/10.1007/s00464-020-08020-6 Crossref PubMed Scopus (6) Google Scholar , 2 Callahan Z.M. Donovan K. Su B.S. et al. Laparoscopic inguinal hernia repair after prostatectomy: evaluating safety, efficacy, and efficiency. Surgery. 2019; 166 (S0039-6060(19)30316-2 [pii]): 607-614 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Dewulf M. Aspeslagh L. Nachtergaele F. Pletinckx P. Muysoms F. Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy. Surg Endosc. 2022; 36 ([doi]): 2105-2112https://doi.org/10.1007/s00464-021-08497-9 Crossref PubMed Scopus (7) Google Scholar , 4 Le Page P. Smialkowski A. Morton J. Fenton-Lee D. Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective. Surg Endosc. 2013; 27 ([doi]): 4485-4490https://doi.org/10.1007/s00464-013-3094-1 Crossref PubMed Scopus (14) Google Scholar , 5 Peitsch W.K.J. Laparoscopic transperitoneal inguinal hernioplasty (TAPP) after radical open retropubic prostatectomy: special features and clinical outcomes. Hernia. 2019; 23 ([doi]): 281-286https://doi.org/10.1007/s10029-018-1846-5 Crossref PubMed Scopus (7) Google Scholar In these studies, there were no statistically significant differences in outcomes such as injuries to surrounding structures, postoperative complications, length of stay (LOS), readmission rate, hernia recurrences, or chronic pain. These studies further demonstrated that there may even be potential benefit to this patient population, including faster return to activities of daily living (ADLs) 2 Callahan Z.M. Donovan K. Su B.S. et al. Laparoscopic inguinal hernia repair after prostatectomy: evaluating safety, efficacy, and efficiency. Surgery. 2019; 166 (S0039-6060(19)30316-2 [pii]): 607-614 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar and advantages in treatment for bilateral inguinal hernias. 3 Dewulf M. Aspeslagh L. Nachtergaele F. Pletinckx P. Muysoms F. Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy. Surg Endosc. 2022; 36 ([doi]): 2105-2112https://doi.org/10.1007/s00464-021-08497-9 Crossref PubMed Scopus (7) Google Scholar In their manuscript, Dr. Amundson et al. compared safety and outcomes of IHR between open, laparoscopic, and robotic approaches with a focus on patient reported quality of life outcomes. 6 Amundson J.R. Attaar M. Forester B. et al. Laparoscopic and robotic inguinal hernia repair are safe and effective after prior pelvic or low abdominal surgery. Am J Surg. 2022; (S0002-9610(22)00508-6 [pii]. In this issue) Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar