Eighteen patients with a prior LMH underwent RRP. Five of the 18 had bilateral LMH, with unilateral LMH in the remainder. Outcomes in this group were compared with 38 patients without prior LMH. There was no difference between the groups in terms of age, preoperative PSA, prostate size, preoperative Gleason score, or body mass index, and RRP was successfully performed in all 18 LMH patients. One of 18 patients had a postoperative complication (persistent JP drainage). Compared with the control group, differences in operative time and blood loss bordered on statistical significance.
Prior LMH is not a contraindication to RRP. While resulting in slightly longer operating times and higher blood loss, our experience suggests that RRP can be safely performed in these patients.
This study from the Medical College of Wisconsin showed how radical prostatectomy can be performed safely after laparoscopic hernia surgery with mesh. My experience with robotic surgery has been similar. Robotic prostatectomy after laparoscopic hernia surgery takes a little more time, but is not too much of a problem.
The first step where the bladder is moved out of the way is more complicated and performing a pelvic lymph node dissection is more complicated as well. Patients of mine who are at risk of developing prostate cancer sometimes develop inguinal hernias. If they are considering undergoing laparoscopic hernia surgery with mesh, I am comfortable with given them the OK.