The Occurrence of Inguinal Hernia after Robotic Assisted Radical Prostatectomy: Clinical Characteristics and Associated Risk Factors
Chyau-Wen Lin1, Eric Yi-Hsiu Huang1,2, Chang-Ho Chiang 1, Yu-Kuang Chen1, Tzu-Hao Huang1,2,
Yen-Hwa Chang1,2, Shing-Hwa Lu1,2, Hsiao-Jen Chung1,2, Tzu-Ping Lin1,2, Chih-Chieh Lin 1,2,
I-Shen Huang1,2, Wei-Jen Chen1,2, William J. Huang1,2
1Department of Urology, Taipei Veterans General Hospital
2Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center,
National Yang Ming Chiao Tung University, Taipei, Taiwan
We aim to investigate the occurrence of inguinal hernia in patients who received robotic assisted radical prostatectomy (RaRP). A matched comparison was also made with non-prostate cancer patients with inguinal hernia.
Material and Methods
This is a single center retrospective study. Patients who developed inguinal hernia after RaRP and received inguinal hernioplasty (RaRP group) were enrolled from 2014 to 2019. Pre- and peri-operative variables were collected. The detailed characteristics of inguinal hernia including laterality, hernia types, size of orifice, and classifications were also recorded. A 1:1 age-matched control group was selected from the patients who received inguinal hernioplasty at the same time frame without prostate cancer. Patients who received totally extra-peritoneal hernioplasty (TEP) were excluded due to no detailed description of hernia orifice size. IBM SPSS 26th version was used in statistical analysis. Chi-square test and independent median test were used as single variate analysis, and median regression was used as multivariate analysis.
In total, 630 patients who received RaRP were enrolled in the study period and 57 patients developed post-operative inguinal hernia with incidence rate of 9.0%. The median time interval between RaRP and the occurrence of inguinal hernia was 9 months (IQR 6-16), and 80% of the patients developed inguinal hernia within 12 months after RaRP. After multivariate analysis between the patients who developed hernia after RaRP with those didn’t develop hernia, showed older age and lower BMI were independent significant risk factors for post-RaRP inguinal hernia (p=0.02 and <0.001 respectively).
There was no difference in BMI between RaRP and control group (p=0.87). However, ECOG was significantly better in RaRP group. There was no difference in the laterality of hernia between RaRP and control goup, but RaRP group had predominantly indirect type (96%), which was significantly higher than control group (54.7%, p=0.001). In addition, RaRP group had more patients with larger size of hernia orifice > 1.5 cm (86.9% vs. 71.9%, p<0.001).
Patients accepting RaRP tend to develop inguinal hernia within a year after RaRP in our experience. Age and BMI were independent risks factors for inguinal hernia in patients with RaRP history. Compared to the age-matched control population, these patients predominately developed indirect hernia with larger hernia orifice.