Current Practices for Preventing Inguinal Hernia During Radical Prostatectomy: Findings From the "Anatomy on the Border" Consensus Survey by the Japan Society for Endoscopic Surgery.

BACKGROUND

Inguinal hernia (IH) occurs relatively frequently after radical prostatectomy (RP) and can impair patients' quality of life. In recent years, most RPs in Japan have been performed robotically; however, strategies for preventing postoperative IH remain diverse and are not clearly defined.

METHODS

In July 2024, the Japan Society for Endoscopic Surgery conducted an anonymous, web-based survey of 114 members of the Japanese Urological Association to assess intraoperative IH prevention practices during RP. Twenty-seven urologists responded (response rate: 24%), providing information on their clinical experience, estimated IH incidence, recognized risk factors, and prevention techniques.

RESULTS

Most respondents were highly experienced: 85% had more than 20 years of practice, 78% had performed over 100 RPs, and 96% routinely used robotic surgery. Seventy-four percent identified both patient- and surgeon-related factors as contributors to IH, and 52% estimated the incidence of IH to be 5%-10%. Preventive measures were used routinely by 22% of respondents, selectively by 33%, and not at all by 45%. Common preventive techniques included ligation and transection of the patent processus vaginalis with peritoneal closure (89%), mobilization of the vas deferens and spermatic cord (70%), and circumferential incision of the internal inguinal ring (70%). Mesh reinforcement was rarely employed (4%), although 74% reported documenting IH risk in the informed consent process.

CONCLUSIONS

Despite limited high-level evidence, Japanese urologists implement diverse intraoperative IH prevention strategies during RP. Prospective multicenter studies and standardized protocols are needed to validate these techniques and reduce postoperative IH rates.