Previous Laparoscopic Hernia Repair with mesh in prostate cancer patients

This past month 2 patients of mine with prior laparoscopic hernia repairs with mesh had successful dvPs. I have done several of these now and do not get overly concerned with this finding in a patient. One of the patient’s was from Florida and was advised against robotic prostatectomy from 2 urologists that performed robotics locally due to his prior hernia surgery. This patient actually had recurrent inguinal hernias that we fixed at the same time of his robotic prostatectomy.

I think the open approach will be much more difficult in patients with prior lap hernias and would advise against open prostate surgery, but I do not feel it is a problem for myself while performing robotics. Operative reports from the original lap hernia operation are helpful. If the lining of the abdomen (peritoneum) is not covered over the mesh, this would make the dvP much harder as bowel would likely be adhered to the mesh. If the lap hernia was done extraperitoneal (this is usually the case) or the peritoneum covers the mesh, it should not be a problem.

Lymph node dissections are much more difficult with prior hernia repairs, especially lap hernias and I performed my first of these for lap hernias this past week and found it to be safe even though the mesh was placed lower than usual and partly covered the vein. I inform patients with prior surgery in this area that I may not be able to remove the lymph nodes if the reaction is too severe and I don’t feel its safe. The lymph nodes are more useful for staging and giving the patient their prognosis, but not for helping the cure rate. Fortunately I have always been able to remove the lymph nodes when I wanted to so far.