Concurrent radical retropubic prostatectomy and inguinal hernia repair through a modified Pfannenstiel incision

Authors from Miami describe their technique of concurrent radical retropubic prostatectomy and inguinal hernia repair through a modified Pfannenstiel incision. They found this approach to be ideal for performing both operations at the same time, allowing a tension‐free mesh hernia repair with excellent exposure of the pelvic structures. An interesting paper from authors in New York reviews patients who had both bladder and lung cancer. Their findings are important in terms of a potential guideline to urologists who have patients with these conditions, and are, for example, faced with the decision as to whether they should operate on someone who has a history of lung cancer but now has bladder cancer. In another paper from the New York area, authors describe the effect on morbidity and mortality of bone metastasis in patients with RCC. They found the effect to be considerable, and suggest a possible role for bisphosphonates. OBJECTIVE To describe a technique for concurrent radical retropubic prostatectomy (RRP) and inguinal hernioplasty, using a modified Pfannenstiel incision. PATIENTS AND METHODS RRP is usually done through a midline lower abdominal incision but some patients with localized prostate cancer have an inguinal hernia. Concurrent inguinal hernia repair at the time of RRP with the usual method is only possible by either a preperitoneal mesh repair or formal hernioplasty, requiring an additional incision(s). A 10–12 cm Pfannenstiel incision is made along the pubic hairline centred over the pubic symphysis, and a ‘Y’‐shaped incision in the rectus sheath. The rectus muscle is split vertically along the midline, followed by RRP. After removing the prostate and completing the anastomosis, the surgeon identifies the inguinal canal along the inferior and lateral aspect of the transverse incision and uses a formal tension‐free hernioplasty with a 3 × 5 cm polypropylene mesh. We used this technique in fifteen concurrent inguinal hernioplasties (two bilateral hernias and thirteen unilateral) at the time of RRP, with no additional incisions, using the formal tension‐free Lichtenstein technique. One patient with bilateral hernias had a right indirect inguinal hernia, and all the remaining men had a direct inguinal hernia. RESULTS All patients were discharged 2 days after surgery, with no complications associated with the procedure and no recurrences; however, the follow‐up was short (mean 5.5 months). CONCLUSION A modified Pfannenstiel incision is ideal for concurrent RRP and inguinal hernioplasty, providing excellent exposure of the pelvic structures and allowing the surgeon to use a formal tension‐free mesh hernioplasty through the same incision. Wound healing and cosmetic results are excellent.