Incisional Hernia After Transperitoneal Robot-assisted Radical Prostatectomy: A Call for Greater Awareness Among Urologists.

Abstract

Incisional hernia (IH) is a clinically relevant yet under-reported complication of transperitoneal robot-assisted radical prostatectomy (RARP). As this approach becomes standard, identification of procedure-specific risk factors to inform prevention strategies is essential to improve surgical outcomes for prostate cancer. We conducted an analysis of patients with localised prostate cancer who underwent transperitoneal RARP with supraumbilical specimen extraction between 2020 and 2024 in three academic centres in France. The primary endpoint was IH prevalence at 1 yr. Independent predictors were identified via multivariable analysis. A total of 629 patients were included. Median age was 61 yr (interquartile range [IQR] 66-70), and median prostate-specific antigen was 6.16 ng/ml (IQR 8.18-12). According to the D'Amico classification, 8% of patients had low risk, 75% had intermediate risk, and 17% had high risk. At 1-yr follow-up, 76 patients (12.1%) had developed IH at the supraumbilical extraction site, of whom 53 (70%) underwent surgical repair. Multivariable analysis identified higher body mass index, smoking, and postoperative parietal abscess as independent risk factors for IH. IH is a relatively frequent yet often overlooked complication of RARP. The IH incidence in our study suggests underdiagnosis of this complication, with potential consequences that include bowel obstruction and chronic pain. Optimisation of fascial closure and reconsideration of the extraction site location might reduce IH risk. Systematic imaging for high-risk patients could improve early detection. PATIENT SUMMARY: We looked at the risk of developing a hernia in the abdomen wall after robotic surgery for prostate cancer. We found that these hernias are more common than previously thought, especially in patients with obesity, smoking habits, or wound infections. A careful surgical technique and closer follow-up may help in reducing the risk of this complication and improve outcomes.