Many men will develop an inguinal hernia after a prostatectomy, or removal of the prostate. Repairing an inguinal hernia after prostate surgery can sometimes be very difficult. Because of the scarring from prostate surgery, the preperitoneal space is challenging to work in, making laparoscopic surgery for inguinal hernia after a prostatectomy very difficult. Most surgeons prefer to use an open anterior approach, and some have started using an advanced laparoscopic platform marketed as “robotic” surgery. This platform may allow a surgeon to place a large piece of mesh under the abdominal muscles in the preperitoneal space, the preferred location. While successful sometime, the robotic approach carries a much higher risk of complications than anterior approches after prostatectomy.
As experts we tailor our recommendations to each patient. Because of the fact that robotic approach, has replaced the open approach for prostate removal, the open preperitoneal approach is not a viable option after the robotic prostatectomy; we offer an anterior approach in this case. We feel that the slight benefit of a posterior approach is not enough to substantiate the added risk of dissecting in the space where the prostate surgery what done.
Over the last 5 years we have started offering the Shouldice, no mesh, inguinal hernia operation. This is a suture only repair of an inguinal hernia from an anterior approach that can be performed safely and effectively in thinner patients. While the Shouldice repair used to be our backup plan to the preperitoneal mesh for patients with a history of prostate surgery, we now recommend it as the first choice, especially as it avoids all the scarring from the prior surgery. In patients who are overweight, and are therefore not good candidates for a no mesh repair, we offer the traditional anterior mesh repair as the backup plan, or primary approach. The decision between “Plan A”, Shouldice, and “Plan B”, Lichtenstein, is sometimes made in the operating room and is dependent on an individual patient’s tissues.
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This was written by Dr. Reinhorn
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. Dr. Reinhorn started his practice as a full service general surgeon in 2001. In 2012 Dr. Reinhorn started to focus on the care of hernia and pilonidal patients. This focused practice has been designed to provide a superior clinical experience. Dr. Reinhorn has published his outcomes and continues to participate in hernia and surgery societies. His research led to a reduction in opioid prescribing after hernia surgery. His team performs more than 500 hernia surgeries every year.