Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea.

ABSTRACT

Background and Objectives: In patients with inguinal hernias who have undergone radical prostatectomy, dissecting the medial preperitoneal space is difficult because of the presence of fibrotic scars. It is also difficult to guarantee sufficient space for mesh implantation. We added laparoscopic iliopubic tract repair (IPTR) to transabdominal preperitoneal (TAPP) hernioplasty, and evaluated this for the treatment of inguinal hernias after radical prostatectomy

Methods: This retrospective study included 29 male patients with inguinal hernias after radical prostatectomy who underwent TAPP hernioplasty between January 1, 2015 and October 31, 2018. Laparoscopic IPTR was performed first, followed by TAPP hernioplasty.

Results: All patients had an indirect inguinal hernia. The mean time from radical prostatectomy to TAPP hernioplasty was 2.1 years (range, 0.3–11 years). In one patient, the peritoneal flap was insufficient, and the operation was performed using a dual-layer mesh. All other patients underwent conventional TAPP hernioplasty. The mean operation time was 42 min (range, 30–50 min), and the mean duration until return to normal activities was 8.4 days. There were two minor postoperative complications (one hematoma and one seroma). The mean follow-up period was 45.8614.0months (range, 22–67 months), and chronic pain or recurrence was not observed.

Conclusion: Adding laparoscopic IPTR to TAPP hernioplasty in patients with a history of radical prostatectomy is feasi- ble and safe, with a low risk of chronic pain and recurrence.

Key Words: Inguinal hernia, Hernioplasty, Prostatectomy, Laparoscopy.

The post Laparoscopic Iliopubic Tract Repair with Transabdominal Preperitoneal Hernioplasty after Radical Prostatectomy first appeared on JSLS.

University of Toledo College of Medicine, Toledo, OH, USA (all authors). Department of Urology, University of Toledo Medical Center, Toledo, OH, USA (Dr. Jain).

ABSTRACT

Introduction: Weck Hem-o-Lok (Teleflex Medical, Research Triangle Park, North Carolina) clips are frequently used to achieve hemostasis of the lateral prostatic pedicles during radical prostatectomy. Rarely, these clips can detach and migrate into the bladder wall, leading to postoperative urinary tract complications. Hem-o-Lok clip migration into the bladder is a rare complication of laparoscopic radical prostatectomy that has been reported within 1 year postsurgery.

Case Report: We report the case of a 61-year-old white man who presented with urinary stress incontinence, acute urinary retention, and a history of recurrent urinary tract infections more than 2 years after salvage robot-assisted laparoscopic radical prostatectomy for recurrent prostate cancer that was unsuccessfully treated with brachytherapy. As part of his diagnostic workup, cystoscopy demonstrated an open bladder neck with no evidence of contracture and the presence of a calcification near the vesicourethral anastomosis. Unroofing these calcifications via laser lithotripsy revealed two eroded Hem-o-Lok clips, which were subsequently removed from the bladder wall.

Conclusion: Salvage prostatectomy after radiotherapy as the primary treatment for prostate cancer may increase the window of time in which intravesical clip migration can occur because of delayed wound healing at the vesicourethral anastomosis. Furthermore, clip migration can present with signs of urinary tract dysfunction in the absence of bladder neck contracture and beyond the time frame initially expected.

Key Words: Prostatic neoplasms, Prostatectomy, Laparoscopy, Urinary incontinence, Postoperative complications.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/08/CRSLS.2014.001683_hi.pdf”]

The post Delayed Hem-o-Lok Clip Erosion Following Salvage Radical Prostatectomy first appeared on JSLS.

Department of Anesthesiology, Hôpital Foch and University Versailles Saint-Quentin en Yvelines, 92150 Suresnes, France (Drs. Pruszkowski, Schlumberger, and Fischler). Department of Cardio-Vascular Radiology, Hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France (Dr. Petit).

ABSTRACT

Introduction: Robotic prostatectomy is considered by many urologists as the new standard of care.

Cases Description: We encountered 2 patients scheduled for a robotic prostatectomy whose past medical history was remarkable for a cerebral palsy that had been considered to be due to a patent foramen ovale. At this time, it was decided that foramen ovale closure was not necessary. Because of the high risk of gas embolism during the robotic prostatectomy, we decided to close the foramen ovale preoperatively. This procedure and the prostatectomy were without any complication.

Conclusions: Our choice of a prophylactic closure of a patent foramen ovale before a procedure at risk of gas embolism is unusual and can be discussed.

Key Words: Foramen Ovale, Laparoscopy, Patent, Prostatectomy, Robotics.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00323.pdf”]

The post Patent Foramen Ovale Closed Before Robotic Radical Prostatectomy first appeared on JSLS.