Abstract：
BACKGROUND: Inguinal hernia develops as one of the common complications after robotic or laparoscopic radical prostatectomy (RP). Transabdominal preperitoneal patch plasty (TAPP) for an inguinal hernia after RP is difficult to perform due to postoperative severe adhesions in the preperitoneal cavity. We have introduced 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 HPIA for patients with an inguinal hernia after robot-assisted RP (RARP).
METHODS: Patients characteristics and surgical outcome were evaluated by a retrospective analysis.
RESULTS: 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 three were type 3a according to the Nyhus classification. A circular incision TAPP was performed for 10 hernia lesions in eight 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 circular incision TAPP (p = .038). The HPIA was complete in all patients, while the circular incision TAPP was converted to intraperitoneal onlay mesh (IPOM)intraperitoneal onlay mesh in five patients (55.6%, p = .008) due to dense adhesions with difficult dissection. No recurrent was observed after follow-up period of 48 months 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.
METHODS: Patients characteristics and surgical outcome were evaluated by a retrospective analysis.
RESULTS: 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 three were type 3a according to the Nyhus classification. A circular incision TAPP was performed for 10 hernia lesions in eight 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 circular incision TAPP (p = .038). The HPIA was complete in all patients, while the circular incision TAPP was converted to intraperitoneal onlay mesh (IPOM)intraperitoneal onlay mesh in five patients (55.6%, p = .008) due to dense adhesions with difficult dissection. No recurrent was observed after follow-up period of 48 months 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.
摘要：
背景：腹股沟疝是机器人或腹腔镜前列腺癌根治术（RP）后常见的并发症之一。RP后腹股沟疝的经腹腹膜前补片成形术（TAPP）由于术后腹膜前腔严重粘连而难以进行。我们在TAPP中引入了一种高腹膜切口方法（HPIA），用于腹股沟疝患者，由于RP后严重粘连而难以进行腹膜解剖。我们评估了TAPP与HPIA对机器人辅助RP（RARP）术后腹股沟疝患者的安全性和有效性。
方法：通过回顾性分析评估患者特征和手术结果。
结果：从2014年1月至2017年12月，连续21例患者在RARP术后接受TAPP治疗腹股沟疝。根据Nyhus分类，24个病变为3b型，3个为3a型。对8例患者的10例疝气病变进行了环形切口TAPP，对13例患者的17例病变使用了HPIA的TAPP。HPIA单侧疝的平均手术时间（137.8±20.7分钟）明显短于圆形切口TAPP的（182.2±42.0分钟）（p=.038）。所有患者的HPIA都完成了，5例患者将圆形切口TAPP转换为腹膜内嵌网（IPOM）腹膜内嵌网（55.6％，p=.008），由于粘连致密，解剖困难。随访48个月后，两组均未出现复发。
结论：对于RARP术后腹股沟疝患者，TAPP联合HPIA是可行的，是一种安全可靠的选择。
方法：通过回顾性分析评估患者特征和手术结果。
结果：从2014年1月至2017年12月，连续21例患者在RARP术后接受TAPP治疗腹股沟疝。根据Nyhus分类，24个病变为3b型，3个为3a型。对8例患者的10例疝气病变进行了环形切口TAPP，对13例患者的17例病变使用了HPIA的TAPP。HPIA单侧疝的平均手术时间（137.8±20.7分钟）明显短于圆形切口TAPP的（182.2±42.0分钟）（p=.038）。所有患者的HPIA都完成了，5例患者将圆形切口TAPP转换为腹膜内嵌网（IPOM）腹膜内嵌网（55.6％，p=.008），由于粘连致密，解剖困难。随访48个月后，两组均未出现复发。
结论：对于RARP术后腹股沟疝患者，TAPP联合HPIA是可行的，是一种安全可靠的选择。
