Long-Term Results of the Plugging Method with Regard to the Prevention of a Postoperative Inguinal Hernia after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Study

Purpose: We previously identified that the existence of a patent processus vaginalis (PPV) is an important risk factor for a postoperative inguinal hernia (IH) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and we introduced a novel plugging method to prevent IH development. The present study aimed to analyze the long-term outcomes of this plugging method. Patients and Methods: A total of 1026 groins were reviewed between May 2007 and March 2016. The plugging method was prospectively applied to patients with a PPV since May 2011. For patients with inguinal discomfort, ultrasonography was used to evaluate IH development. Results: An IH developed postoperatively in 35 (3.4%) groins at a median time of 22.0 months during a median follow-up of 41 months. Of the 291 groins with a PPV, plugging was performed in 167 (57.4%) groins. The presence of a PPV without the preventive procedure was a major risk factor for a postoperative IH. No prognostic difference in IH development was noted between the group without a PPV and the group with a PPV that underwent the plugging method. Body mass index (≥23.0 kg/m²) and presence of a PPV were independent predictors for IH development in groins that did not undergo the plugging method. For groins that underwent the plugging method, previous operation history was an independent predictor. Conclusions: The plugging method is effective for long-term prevention of postoperative IHs in patients undergoing RALP.