Original Article 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 post-operative 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 prosta-tectomy from November 2000 to November 2007, and evaluated various preoperative par-ameters, 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 prostatect-omy, and the incidence of inguinal hernia is greater with the extraperitoneal approach than with the transperitoneal approach. Key words: inguinal hernia – radical prostatectomy – laparoscopy – extraperitoneal approac