Laparoscopic repair of extraction site ventral hernia after robotic prostatectomy: institutional experience with 42 consecutive cases.

INTRODUCTION: Robotic-assisted laparoscopic prostatectomy (RALP) has become one of the most common laparoscopic procedures in the United States, with over 80,000 cases performed yearly. There is increasing awareness that extraction site ventral hernias (ESVH) are an important cause of morbidity after laparoscopic resective surgery. However, there is no data in the literature concerning ESVH after RALP. The purpose of this study is to report our experience with this novel ESVH and our results with its laparoscopic (LAP) repair.
METHODS: The charts of all patients subjected to LAP VH repair at the City of Hope National Medical Center between 2005 and 2009 were retrospectively reviewed. Only patients undergoing LAP ESVH after RALP were included in the study. Relevant data analyzed included patient demographics, operative parameters, complications, and recurrence.
RESULTS: A total of 42 consecutive male patients were identified, with a median age of 65 years (range 46-81). The median time from RALP to ESVH repair was 10 months (range 1-43). All hernias were periumbilical and all were symptomatic. A laparoscopic left lateral approach was used in all cases. The median operative time was 91 min (range 61-162). The median defect area was 64 cm(2) (range 4-176), which was repaired with polytetrafluoroethylene (PTFE) (18 cases) or Marlex composite mesh (24 cases) with a 5-cm overlap. The estimated blood loss (EBL) was minimal in all cases. The median hospital stay was 1 day (range 0-4). Minor complications occurred in 14% of cases. There was no mortality and the recurrence rate was 0%.
CONCLUSIONS: ESVH after RALP are likely to become a common cause of abdominal wall morbidity in the near future. A laparoscopic repair is safe and effective. Prospective studies are needed in order to further investigate ESVH and ways to reduce its incidence.