근치적후치골전립선절제술 후 발생한 서혜부탈장의 빈도 및 유발 인자 = The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP).
Materials and Methods: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model.
Results: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p＜0.001), prostate volume(p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection(p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time(p=0.039), pelvic lymph node dissection(p=0.002), the presence of transfusion(p=0.012) and the prostate volume(＞50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia.
Conclusions: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP).
Materials and Methods: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model.
Results: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p＜0.001), prostate volume(p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection(p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time(p=0.039), pelvic lymph node dissection(p=0.002), the presence of transfusion(p=0.012) and the prostate volume(＞50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia.
Conclusions: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.

참고문헌 (Reference)

1 Stranne J, "hernia is a common complication in lower midline incision surgery" 11 : 247-52, 2007

2 Hautmann RE, "Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases" 43 : 47-51, 1994

3 Fischer E, "Radical retropubic prostatectomy and groin hernia-cause and effect?" 1 : 67-9, 1997

4 Twu CM, "Predicting risk factors for inguinal hernia after radical retropubic prostatectomy" 66 : 814-8, 2005

5 Abe T, "Postoperative inguinal hernia after radical prostatectomy for prostate cancer" 69 : 326-9, 2007

6 Stranne J, "Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection" 176 : 2072-6, 2006

7 Fowler FJ Jr, "Patient-reported complications and follow-up treatment after radical prostatectomy" 42 : 622-9, 1993

8 Nomura T, "Lower incidence of inguinal hernia: minilaparotomy radical retropubic prostatectomy compared with conventional technique. A preliminary report" 74 : 32-7, 2005

9 Stranne J, "Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy-an analysis of 1,105 patients" 65 : 847-51, 2005

10 Tsai PJ, "Inguinal hernia after radical retropubic prostatectomy: experience of Kaohsiung Veterans General Hospital" 67 : 141-4, 2004

11 Lodding P, "Inguinal hernia after radical retropubic prostatectomy for prostate cancer: a study of incidence and risk factors in comparison to no operation and lymphadenectomy" 166 : 964-7, 2001

12 Regan TC, "Incidence of inguinal hernias following radical retropubic prostatectomy" 47 : 536-7, 1996

13 Ichioka K, "Impact of retraction of vas deferens in postradical prostatectomy inguinal hernia" 70 : 511-4, 2007

14 Ichioka K, "High incidence of inguinal hernia after radical retropubic prostatectomy" 63 : 278-81, 2004

15 Eubanks WS, "Hernias.; In:SABISTON textbook of surgery: the biological basis of modern surgical practice. 16th ed" Saunders 783-801, 2001

16 Nehme AE, "Groin hernias in elderly patients. Management and prognosis" 146 : 257-60, 1983

17 Scott J, "Development of inguinal hernia following appendectomy" 117 : 344-5, 1960

18 Rutkow IM, "Demographic and socioeconomic aspects of hernia repair in the United States in 2003" 83 : 1045-51, 2003