News Feed Discussions laparoscopic repair and prostate surgery

  • laparoscopic repair and prostate surgery

    Posted by pbrown on February 16, 2015 at 1:15 pm

    I have read that laparoscopic hernia repair complicates future prostate surgery. In particular, it is claimed that previous laparoscopic hernia repair makes it very difficult to dissect pelvic lymph nodes. Given that the probability that a male will have prostate cancer in his lifetime is around 15%, to what extent should this be a concern in choosing laparoscopic repair over open repair?

    drtowfigh replied 9 years, 4 months ago 2 Members · 1 Reply
  • 1 Reply
  • drtowfigh

    Moderator
    February 16, 2015 at 5:41 pm

    laparoscopic repair and prostate surgery

    Excellent question. This topic has been debated since the introduction of laparoscopic inguinal hernia repair with mesh.

    Most modern day studies, where prostatectomy operations are performed robotic-assisted, have shown no significant problems after laparoscopic inguinal hernia repair with mesh. That is, patients were able to undergo uneventful robotic-assisted radical prostatectomy after having had laparoscopic inguinal hernia repair.

    The caveat is: the laparoscopic mesh must be appropriately placed:
    a) the bladder must be out of the way during the hernia repair, otherwise the mesh is more likely to involve the bladder. I routinely place a Foley urinary catheter during the operation to assure this. Many surgeons do not do this but have the patients urinate prior to the operation.
    b) the mesh must not be placed any lower than the pubic bone (pubis). Any lower, it will involve too much of the vessels and the lymph nodes and may not only complicate future need for lymph node dissection but also may cause groin symptoms after hernia surgery.

    Other things to know about hernia repair and prostate surgery:
    – Open prostate surgery is very difficult to perform after laparoscopic inguinal hernia repair with mesh. It is not impossible, but there are reports of some surgeons having to abort the prostate surgery due to the amount of scar tissue and the mesh obliterating the space where they need to access the bladder. That said, these are older studies where the techniques used for laparoscopic hernia surgery were not as refined as they are today. Also, urologists are more aware of how laparoscopic inguinal hernia repairs are performed by their general surgery colleagues and therefore they able to work around the area to be able to complete the prostatectomy. My own father had an open prostatectomy after laparoscopic bilateral inguinal hernia repair with mesh and it was not an issue.
    – Open inguinal hernia surgery may involve mesh placed in the same space (retroperitoneum, or space of Retzius) as laparoscopic hernia repair. The mesh may be the Plug, the Prolene Hernia System, or the Kugel patch. These open repairs may also affect prostate surgeons and there are reports of mesh plugs migrating into areas where the urologists needed to perform the lymph node dissection. Of course, this is not a common problem, but just be aware that open inguinal hernia repair may also involve retroperitoneal or posterior mesh placement, similar to laparoscopic repair.

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