Consensus Statement on the Management of Inguinal Hernias Following Radical Prostatectomy: A Delphi-Based Expert Panel Report From Anatomy on the Border (AOB) at the 37th Annual Meeting of the Japan Society for Endoscopic Surgery.

Abstract

<h4>Introduction</h4>Inguinal hernia is a common complication following radical prostatectomy, yet preventive and therapeutic strategies remain inconsistent across specialties.<h4>Methods</h4>Clinical questions addressing etiology, prevention, and treatment were developed through a literature review and a nationwide survey of general surgeons and urologists. Consensus recommendations were subsequently refined using the Delphi method by an expert panel.<h4>Results</h4>Among respondents, 66% managed more than 101 hernia cases annually, and 85% had over 20 years of surgical experience. Surgeons primarily emphasized the transversalis fascia (91%) and preperitoneal fascia (65%), whereas urologists focused on the flank pad (70%) and lateroconal fascia (67%). Most surgeons (84%) identified an association between radical prostatectomy and subsequent hernia formation, with urologists attributing causation to both patient-related and surgical factors. Repair after prostatectomy was mainly performed by open anterior approaches (80%), whereas laparoscopic transabdominal preperitoneal repair (TAPP) (20%) was less common and frequently perceived as challenging. Nearly half of respondents preferred leaving a dilated internal ring untreated, while 43% reported that preoperative hernia required no consultation. Simultaneous repair at the time of prostatectomy was rare (15%), and 72% considered prophylactic intervention unnecessary. Based on these findings, a clinical question and recommendation were formulated and, in the final Delphi round, unanimously endorsed with 100% agreement among experts.<h4>Conclusion</h4>Marked specialty-based differences in perception and practice were observed. Evidence for prophylactic or simultaneous repair remains insufficient. Anterior mesh repair, or laparoscopic repair by experienced surgeons, is recommended. This consensus underscores the importance of interdisciplinary collaboration and evidence-based management of post-prostatectomy inguinal hernia.