Laparoscopic prostatectomy has been performed in patients with a variety of previous surgical histories.2
To our knowledge, this is the first reported case of laparoscopic radical prostatectomy following laparoscopic bilateral mesh hernia repair. Katz et al3
recently reported on the difficulty of open radical prostatectomy in 2 patients after laparoscopic herniorrhaphy. One patient was deemed inoperable because of complete obliteration of the space of Retzius, while a second patient had a difficult prostatectomy after removal of the mesh.
Currently, a history of previous hernia surgery however has been an exclusion criteria for laparoscopic prostatectomy.2
Our patient was successfully treated laparoscopically without untoward effects. The mesh was completely covered by the peritoneum with no significant adhering viscera. The fibrosis encountered in the space of Retzius did not compromise the mobilization of the bladder. The transabdominal route negated the need to mobilize the mesh from the anterior abdominal wall. The mesh was stapled to the pubic bone in the midline but did not extend to the level of the puboprostatic ligaments or endopelvic fascia.
The interval between the previous hernia surgery and the laparoscopic prostatectomy may have been the most significant factor making this operation feasible. Meticulous closure of the peritoneum over the mesh by the previous surgeon may have also been a contributing factor. Despite the feasibility of this operation, patients with a recent laparoscopic hernia repair should be counseled regarding the difficulty of this operation and the possibility for conversion to open surgery. Those who present several years following mesh herniorrhaphy may benefit from a laparoscopic approach.