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The relationship between inguinal hernia and minimally-invasive surgery for prostate cancer: A systematic review of the literature
La relación entre hernia inguinal y cirugía mínimamente invasiva para el cáncer de próstata: revisión sistemática de la literatura
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R. Bertoloa, M.C. Mir Maresmab, P. Bovea, J. Rubio-Brionesb, M. Ramírez-Backhausb,
Corresponding author
ramirezfivo@gmail.com

Corresponding author.
a San Carlo di Nancy Hospital, Rome, Italy
b Department de Urología, Fundación IVO, Valencia, Spain
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Received 28 June 2019. Accepted 28 October 2019
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Table 1. Available studies comparing different surgical approaches to radical prostatectomy and the incidence of inguinal hernia.
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Abstract
Objective

We aimed to perform a systematic review about the relationship between inguinal hernia and surgery for prostate cancer.

Background

Diagnosis of abdominal wall defects and prostate cancer may be either synchronous or metachronous. The convenience and safety of combined prostatectomy and hernioplasty, the incidence of hernias after prostatectomy and the feasibility of prostatectomy in patients with previous laparoscopic hernioplasty are still debated.

Methods

PubMed and Embase were queried by dedicated search strings. Two researchers independently reviewed the pooled references and selected the articles of interest, including reviews.

Results

Sixty-five studies were evaluated. 22 studies analysed the feasibility and the outcomes of a combined surgery, namely one-stage radical prostatectomy and herniorrhaphy or hernioplasty. Literature evidences support the combined intervention to patients suffering from an inguinal hernia and a prostate cancer amenable of radical prostatectomy. 16 studies addressing the potential increase in the occurrence of inguinal hernia after radical prostatectomy were evaluated. Approximately 15% of patients who undergo retro-pubic radical prostatectomy will develop inguinal hernia. It is suggested that the incidence might be lower in laparoscopic prostatectomy series, particularly in case of transperitoneal approach. The median time to the appearance of the hernia is around 6 months. After evaluation of 14 studies, it is concluded that laparoscopic hernioplasty does not preclude prostatectomy but hinders further pelvic surgery.

Conclusions

One-stage combined hernioplasty and radical prostatectomy may be accepted except in cases of lymph-nodes dissection and/or positive hydro-distress test of the urethro-vesical anastomosis. Accurate patient’s counselling and dedicated consent form are mandatory, in the setting of an experienced multidisciplinary team.

Keywords:
Inguinal hernia
Prostate cancer
Radical prostatectomy
Laparoscopy
Hernioplasty
Surgery
Resumen
Objetivo

Hemos realizado una revisión sistemática sobre la relación entre la hernia inguinal yla cirugía para el cáncer de próstata.

Contexto

El diagnóstico de defectos de la pared abdominal y el cáncer de próstata puedesuceder de manera sincrónica o metacrónica. La utilidad y seguridad de la cirugía combinada, laincidencia de hernias tras la cirugía prostática y la viabilidad de la prostatectomía en pacientescon hernioplastia laparoscópica previa siguen siendo debatidas hoy en día.

Métodos

Se consultaron PubMed y Embase con los textos de búsqueda correspondientes. Demanera independiente, 2 investigadores revisaron las referencias bibliográficas y seleccionaronlos artículos de interés, incluyendo revisiones.

Resultados

Se evaluaron 65 estudios, 22 de los cuales analizan la viabilidad y los resultadosde una cirugía combinada (prostatectomía radical y herniorrafia o hernioplastia en un mismoacto quirúrgico). La bibliografía respalda la intervención combinada en pacientes que padecenuna hernia inguinal y un cáncer de próstata subsidiario de prostatectomía radical. Se evaluaron16 estudios que abordan el potencial incremento de las hernias inguinales tras una prostatec-tomía radical. Aproximadamente un 15% de los pacientes que reciben prostatectomía radicalretropúbica clásica desarrollarán hernias inguinales. Es posible que esta incidencia se vea redu-cida en la prostatectomía laparoscópica, y probablemente sea menor aún con el abordajetransperitoneal. El tiempo medio hasta la aparición de la hernia es de alrededor de 6 meses.Tras la evaluación de 14 estudios, se concluye que la hernioplastia laparoscópica no imposibilitala prostatectomía, pero dificulta la cirugía pélvica ulterior.

Conclusiones

La hernioplastia y la prostatectomía radical combinadas en un mismo acto quirúr-gico son aceptables, excepto en el caso de estar indicada la linfadenectomía o si la anastomosisuretrovesical no queda estanca a la hidrodistensión intraoperatoria. El asesoramiento adecuado del paciente y el formulario de consentimiento informado son obligatorios en el marco de unequipo multidisciplinario experimentado.

Palabras clave:
Hernia inguinal
Cáncer de próstata
Prostatectomía radical
Laparoscopia
Hernioplastia
Cirugía

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