Laparoscopic Totally Extraperitoneal Hernia Repair after Radical Prostatectomy or Lower Abdominal Surgery Except for Appendectomy – Experience of 35 Cases

Purpose: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. Methods: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. Results: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). Conclusion: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.