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.

Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.