Incidence of inguinal hernia after radical prostatectomy: a systematic review and meta-analysis.

Alder, Rasmus; Zetner, Dennis; Rosenberg, Jacob

PURPOSE To investigate the incidence of inguinal hernia following radical prostatectomy, we compared the incidence of inguinal hernia after open retropubic radical prostatectomy with the laparoscopic and robot-assisted radical prostatectomies, and with control groups. MATERIALS AND METHODS We included all original articles investigating patients treated with radical prostatectomy for localized prostate cancer and reporting data on inguinal hernia incidence. PubMed and EMBASE were searched on 28 February 2018. A meta-analysis was conducted as a weighted and pooled estimate of the incidence of inguinal hernia. The risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration's tool for randomized clinical trials. RESULTS We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia after open retropubic radical prostatectomy was 13.7% (95% CI = 12.0-15.4%), 7.5% (5.2-9.8%) after laparoscopic radical prostatectomy, and 7.9% (5.0-10.9%) after robot-assisted laparoscopic radical prostatectomy. In studies comparing incidence of inguinal hernia after open prostatectomy versus no treatment, the incidence was significantly higher in the radical prostatectomy group 11.7% (95% CI = 9.2-14.2%) vs. 3.3% (2.0-4.6%). Two out of three studies reported a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomy, when compared with a control group. Most studies exploring intraoperative inguinal hernia prevention techniques found a significantly lower inguinal hernia incidence in the experimental group. The inguinal hernias that developed after radical prostatectomy were primarily indirect 81.9% (95% CI = 75.3-88.4%). CONCLUSION We found a high incidence of inguinal hernia following radical prostatectomy, and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was found after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomy. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy compared with control groups, with some evidence to support the same for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies investigating intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.