Masakazu Ohuchi1, Masaki Fukunaga2, Kunihiko Nagakari2, Daisuke Azuma2, Shintaro Kohama2, Jun Nomoto2, Kazuhiro Sakamoto3. 1. Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. ouchimasakazu@yahoo.co.jp. 2. Department of Gastrointestinal Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. 3. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 3-1-3 Hongou Bukyo-ku, Tokyo, 113-8431, Japan.
Abstract
PURPOSE: The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases. METHODS AND MATERIALS: From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes. RESULTS: The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients. CONCLUSION: In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.
PURPOSE: The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases. METHODS AND MATERIALS: From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes. RESULTS: The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPPpatients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPPpatients. CONCLUSION: In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.
Authors: C M P Claus; J C U Coelho; A C L Campos; A M Cury Filho; M P Loureiro; D Dimbarre; E A Bonin Journal: Hernia Date: 2013-12-20 Impact factor: 4.739
Authors: R Bittner; M E Arregui; T Bisgaard; M Dudai; G S Ferzli; R J Fitzgibbons; R H Fortelny; U Klinge; F Kockerling; E Kuhry; J Kukleta; D Lomanto; M C Misra; A Montgomery; S Morales-Conde; W Reinpold; J Rosenberg; S Sauerland; C Schug-Pass; K Singh; M Timoney; D Weyhe; P Chowbey Journal: Surg Endosc Date: 2011-07-13 Impact factor: 4.584
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