Extraperitoneal approach induces postoperative inguinal hernia compared with transperitoneal approach after laparoscopic radical prostatectomy

Objective: The aim of this study was to determine the incidence and risk factors of postoperative inguinal hernia and to investigate whether the difference of approach could induce postoperative inguinal hernia after laparoscopic radical prostatectomy. Methods: We reviewed 493 consecutive patients who underwent laparoscopic radical prostatectomy from November 2000 to November 2007, and evaluated various preoperative parameters, specifically age, prostate-specific antigen (ng/ml), body mass index (kg/m²), prostate volume (ml), previous major abdominal surgery, previous appendectomy, previous inguinal hernia repair and laparoscopic approach as risk factors for postoperative inguinal hernia. Results: Inguinal hernia occurred in 4 (4.9%) of the 81 patients in the transperitoneal approach group, and in 37 (9.0%) of the 412 patients in the extraperitoneal approach group. The overall incidence of inguinal hernia was 8.3% (41 of 493 patients). The median inguinal hernia-free survival time was 35 months and 6 months in the transperitoneal approach and extraperitoneal approach groups, respectively. Inguinal hernia developed within 2 years after surgery in 2 (50%) of 4 patients in the transperitoneal approach group, in 34 (91.9%) of 37 patients in the extraperitoneal approach group, for a total of 36 (87.8%) of 41 patients overall. Multivariate analysis showed that the extraperitoneal approach was a significant risk factor (P = 0.043) for inguinal hernia. Conclusions: Inguinal hernia is a frequent complication after laparoscopic radical prostatectomy, and the incidence of inguinal hernia is greater with the extraperitoneal approach than with the transperitoneal approach.