Inguinal Hernia and Prostatectomy

[Updated May 20, 2014] One of the least known side effects of prostatectomy is that inguinal hernia (IH) occurs as a complication in a 10% - 20% of patients after 1 or 2 years post surgery. It appears that IH is often associated with pre-existing subclinical hernias and may be due to the incision itself as the incidence is similar to other lower abdominal surgeries.

• In a 2007 paper, Japanese investigators noted that the incidence of inguinal hernia after surgery was 17% (9 of 53), 14.0% (6 of 43), and 1.4% (1 of 74) in open RRP, LRP, and radiotherapy groups, respectively. The risk of hernia was statistically significant in the RRP and LRP groups.


• After noting similar figures, namely that inguinal hernias occur in 15% of men 1 to 2 years after prostatectomy, Nielsen and Walsh examined 403 men at the time of surgery and found that one third had pre-existing hernias. If pre-existing hernias were repaired at the time of surgery they did not recur.


• Fukuta et al concluded that subclinical inguinal hernia was highly predictive of post prostatectomy inguinal hernia with 60% of those with subclinical inguinal hernia experiencing post-operative hernias vs. 10% in the normal group after 12 months.


• Johan Stranne in his thesis says "lower midline incision surgery in men aged 55-75 years causes inguinal hernia in 10 to 20%. This is of particular interest considering the rapidly increasing number of RRPs performed." He attributes the results to the "incision itself as the cause of the lesion, causing a direct disruption of the "shutter mechanism” of the inguinal anulus internus. Constitutional factors such as defective supportive tissue and/or the presence of subclinical inguinal hernias probably contribute to varying degrees in the individual patient."

There are some post-op instructions for hernia repair surgery [here], [here], [here], [here], [here], [here] and [here]; however, these are all based on a separate operation. In the case of a concurrent hernia repair the operation could be done from the inside in which case there would be no extra incision so portions of these instructions relating to that would not be relevant.

Complications. According a 2012 article in the Wall Street Journal "More than 30% of patients may suffer from long-term chronic pain and restricted movement after surgery to fix a hernia". A Free iPhone App [direct link] to forecast pain after hernia operations is available. Additional information on complications was reported on in another Wall Street Journal article [here].

The abstract to a Chochrane database systematic review of the Shouldice technique is available at [PMID: 22513902].

Sources:

Abe T, Shinohara N, Harabayashi T, Sazawa A, Suzuki S, Kawarada Y, Nonomura K. Postoperative Inguinal Hernia After Radical Prostatectomy. Urology, 2007 Jan 30; [Epub ahead of print] [PMID: 17275071]

Fukuta F, Hisasue S, Yanase M, Kobayashi K, Miyamoto S, Kato S, Shima M,
Tsukamoto T, Takatsuka K. Preoperative computed tomography finding predicts
for postoperative inguinal hernia: new perspective for radical
prostatectomy-related inguinal hernia. Urology. 2006 Aug;68(2):267-71.
[PMID: 16904432]

Nielsen ME, Walsh PC. Systematic detection and repair of subclinical inguinal hernias at radical retropubic prostatectomy. Urology. 2005 Nov;66(5):1034-7.
[PMID: 16286119]

Johan Stranne, Inguinal Hernia after Urologic Surgery in Males with Special Reference to Radical Retropubic Prostatectomy, A Clinical, Epidemiological and Methodological Study. Department of Urology, Institute of Clinical Sciences,
The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Göteborg 2006. [link]

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RP vs. LRP vs. RLRP - Part 1. Open Surgery (RP)
RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery (LRP)
RP vs. LRP vs. RLRP - Part 3. Robotic Surgery (RLRP)
RP vs. LRP vs. RLRP - Part 4. What Surgeons and Others Say

Choosing a Surgeon - Part 1. Considerations
Choosing a Surgeon - Part 2. Finding a Surgeon

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