High peritoneal incision approach in endoscopic transabdominal preperitoneal patch plasty (TAPP) for inguinal hernia after radical prostatectomy

Abstract Background: Inguinal hernia develops as one of the common complications after robotic or laparoscopic radical prostatectomy (RP). TAPP for an inguinal hernia after RP is far from easy to perform due to postoperative severe adhesions in the preperitoneal cavity. We recently devised a high peritoneal incision approach (HPIA) in TAPP for inguinal hernia patients in whom peritoneal dissection is difficult due to severe adhesions after RP. We evaluate the safety and efficacy of TAPP with a high peritoneal incision approach for patients with an inguinal hernia after Robot-assisted radical prostatectomy. Methods Patients characteristics and surgical outcome were evaluated by a retrospective analysis. Result: From January 2014 to December 2017, 21 consecutive patients underwent TAPP for an inguinal hernia after RARP. Twenty-four lesions were the Type 3b and 3 were Type 3a according to the Nyhus classification. A conventional TAPP was performed for 10 hernia lesions in 8 patients and TAPP with HPIA was utilized for 17 lesions in 13 patients. The mean operation time for the unilateral hernia in the HPIA (137.8±20.7 min) was significantly shorter than that (182.2±42.0 min) in the conventional TAPP (p =0.038). The HPIA was complete in all patients, while the conventional TAPP was converted to IPOM in 5 patients (55.6%, p=0.008) due to dense adhesions with difficult dissection. No recurrent was observed after follow-up period of 24months in both groups. Conclusions: The TAPP with HPIA is feasible and a safe and reliable treatment of choice in patients with an inguinal hernia after RARP.