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What lies beneath – No need to fear a minimally invasive approach to inguinal hernia repairs after prior low abdominal surgery

Published:October 20, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.045
      Inguinal hernia repair (IHR) is one of the most commonly performed surgeries by general surgeons. Prior pelvic or low abdominal surgery has been previously considered by many surgeons to be a contraindication to minimally invasive IHR due to the scar tissue formed in the operative space, which may create an increased level of difficulty and an added potential risk for complications.
      • Angus A.
      • DeMare A.
      • Iacco A.
      Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database.
      However, many recent studies have demonstrated that repair with minimally invasive techniques can be safe in patients who have undergone prior pelvic or low abdominal surgery.
      • Angus A.
      • DeMare A.
      • Iacco A.
      Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database.
      • Callahan Z.M.
      • Donovan K.
      • Su B.S.
      • et al.
      Laparoscopic inguinal hernia repair after prostatectomy: evaluating safety, efficacy, and efficiency.
      • Dewulf M.
      • Aspeslagh L.
      • Nachtergaele F.
      • Pletinckx P.
      • Muysoms F.
      Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy.
      • Le Page P.
      • Smialkowski A.
      • Morton J.
      • Fenton-Lee D.
      Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective.
      • Peitsch W.K.J.
      Laparoscopic transperitoneal inguinal hernioplasty (TAPP) after radical open retropubic prostatectomy: special features and clinical outcomes.
      In these studies, there were no statistically significant differences in outcomes such as injuries to surrounding structures, postoperative complications, length of stay (LOS), readmission rate, hernia recurrences, or chronic pain. These studies further demonstrated that there may even be potential benefit to this patient population, including faster return to activities of daily living (ADLs)
      • Callahan Z.M.
      • Donovan K.
      • Su B.S.
      • et al.
      Laparoscopic inguinal hernia repair after prostatectomy: evaluating safety, efficacy, and efficiency.
      and advantages in treatment for bilateral inguinal hernias.
      • Dewulf M.
      • Aspeslagh L.
      • Nachtergaele F.
      • Pletinckx P.
      • Muysoms F.
      Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy.
      In their manuscript, Dr. Amundson et al. compared safety and outcomes of IHR between open, laparoscopic, and robotic approaches with a focus on patient reported quality of life outcomes.
      • Amundson J.R.
      • Attaar M.
      • Forester B.
      • et al.
      Laparoscopic and robotic inguinal hernia repair are safe and effective after prior pelvic or low abdominal surgery.
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      References

        • Angus A.
        • DeMare A.
        • Iacco A.
        Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database.
        Surg Endosc. 2021; 35 ([doi]): 5310-5314https://doi.org/10.1007/s00464-020-08020-6
        • Callahan Z.M.
        • Donovan K.
        • Su B.S.
        • et al.
        Laparoscopic inguinal hernia repair after prostatectomy: evaluating safety, efficacy, and efficiency.
        Surgery. 2019; 166 (S0039-6060(19)30316-2 [pii]): 607-614
        • Dewulf M.
        • Aspeslagh L.
        • Nachtergaele F.
        • Pletinckx P.
        • Muysoms F.
        Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy.
        Surg Endosc. 2022; 36 ([doi]): 2105-2112https://doi.org/10.1007/s00464-021-08497-9
        • Le Page P.
        • Smialkowski A.
        • Morton J.
        • Fenton-Lee D.
        Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective.
        Surg Endosc. 2013; 27 ([doi]): 4485-4490https://doi.org/10.1007/s00464-013-3094-1
        • Peitsch W.K.J.
        Laparoscopic transperitoneal inguinal hernioplasty (TAPP) after radical open retropubic prostatectomy: special features and clinical outcomes.
        Hernia. 2019; 23 ([doi]): 281-286https://doi.org/10.1007/s10029-018-1846-5
        • Amundson J.R.
        • Attaar M.
        • Forester B.
        • et al.
        Laparoscopic and robotic inguinal hernia repair are safe and effective after prior pelvic or low abdominal surgery.
        Am J Surg. 2022; https://doi.org/10.1016/j.amjsurg.2022.08.011
        • Dulucq J.L.
        • Wintringer P.
        • Mahajna A.
        Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery: is it safe? A prospective study.
        Surg Endosc. 2006; 20 ([doi]): 473-476https://doi.org/10.1007/s00464-006-3027-3
        • Al-Sahaf O.
        • Al-Azawi D.
        • Fauzi M.Z.
        • Cunningham F.O.
        • McGrath J.P.
        Totally extraperitoneal laparoscopic inguinal hernia repair is a safe option in patients with previous lower abdominal surgery.
        J Laparoendosc Adv Surg Tech. 2008; 18 ([doi]): 353-356https://doi.org/10.1089/lap.2007.0071
        • Prassas D.
        • Rolfs T.M.
        • Knoefel W.T.
        • Krieg A.
        Meta-analysis of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery.
        Br J Surg. 2019; 106 ([doi]): 817-823https://doi.org/10.1002/bjs.11140