前立腺全摘後鼠径ヘルニア予防における単純精索剥離の効果

Abstract

Blunt dissection of the peritoneum at the internal inguinal ring and isolation of the spermatic cord from the peritoneum have been demonstrated to be effective for the prevention of post radical prostatectomy (RRP) inguinal hernia. We tested the efficacy of this simple procedure and analyzed the factors affecting the incidence of inguinal hernia. Of the 298 patients who underwent open RRP for clinically localized prostate cancer between February 2005 and March 2011 at Saitama Cancer Center hospital, 186 patients received the simple prophylactic procedure of inguinal hernia. We evaluated the risk factors of inguinal hernia (age, time of operation, intraoperative bleeding, prophylactic procedure of inguinal hernia, previous history of abdominal surgery, previous history of inguinal hernia surgery, nerve sparing, lymph node dissection, body-mass-index (BMI), hypertension, diabetes, and smoking) by univariate and multivariate analysis. Effects of the simple prophylactic procedure on incidence of inguinal hernia were analyzed using Kaplan-Meier plots. The incidence of inguinal hernia was 29.6% in those without the prophylactic procedure, and 11.4% in those with the prophylactic procedure. In univariate and multivariate analysis, only low BMI was a significant risk factor for inguinal hernia after RRP. Accordingly, the incidence of inguinal hernia was not affected by the prophylactic procedure in Kaplan-Meier analysis. Though the simple prophylactic procedure might be useful for prevention of post-radical prostatectomy inguinal hernia, its efficacy was demonstrated to be limited.