Repair of inguinal hernias using the mesh technique during extraperitonealpelvic lymph node dissection

Purpose:This article describes our experience of using a totally extraperit oneal approach for endoscopic pelvic lymphadenectomy and inguinal hernia re pair with the mesh technique in one procedure. Materials and Methods: A tot al of 52 patients underwent modified pelvic lymph node dissection for the s taging of prostate cancer. Eight of them had hernia defects; 1 was recurren t. Five patients with direct and 3 patients with indirect inguinal hernias were treated by totally extraperitoneal hernia repair with the placement of a mesh measuring at least 10 x 15 cm (prolene mesh with incision and flap) . Results: The mean duration of the lymphadenectomy itself was decreased fr om 150 min (first 20 patients) to 70 min (n = 21-52). The mean additional p rocedure time for hernioplasty was 15 min. The overall lymph node-positive rate was 9.6%. The complication rate was 7.7%. Four patients developed symp tomatic lymphoceles, 1 of whom developed deep venous thrombosis. No complic ations occurred which were attributed to hernia repair. Morbidity did not r ise, and hospitalization time did not increase for the patients who underwe nt hernioplasty. There were no recurrences or neuralgias on follow-up up to 2 years. Conclusions: By avoiding entry into the peritoneal cavity, the ex traperitoneal approach obviates intraabdominal complications (ileus, bowel injury, peritonitis) in both techniques. The extraperitoneal approach for p elvic lymph node dissection allows concomitant inguinal hernia to be repair ed with low morbidity and within an acceptable operating time. Copyright (C ) 2001 S. Karger AG, Basel.