Outcomes and evolving surgical trends in inguinal hernia repair following prior urologic surgery: a 15-year single-center retrospective cohort study

PURPOSE: Previous urologic surgeries, including prostatectomy and cystectomy, are associated with an increased risk of inguinal hernia and may complicate subsequent hernia repair due to adhesions and altered pelvic anatomy. However, evidence regarding the optimal surgical approach and outcomes in this population remains limited and inconsistent. This study aimed to investigate the outcomes of inguinal hernia surgery in patients with and without a history of urologic surgery and to examine evolving surgical trends over time. METHODS: This single-center retrospective cohort study included adult male patients (≥ 18 years) who underwent primary inguinal hernia repair between January 2010 and December 2024. Patients were categorized according to a history of prior urologic surgery involving retropubic dissection. The primary outcome was the postoperative complication rate, and the secondary outcomes was hernia recurrence. Multivariate regression analyses were performed to identify factors associated with outcomes. RESULTS: Among 927 patients included in the analysis (826 without and 101 with prior urologic surgery), there were no significant differences in postoperative complication rates between groups (22.8% vs. 24.0%, p = 0.805), nor recurrence rates (1.0% vs. 4.2%, p = 0.186). However, operative time was significantly longer in the urologic group (87.0 vs. 68.4 min, p < 0.001). Multivariable analysis showed that prior urologic surgery was independently associated with longer operative time but not with increased postoperative complications or recurrence. Open repair was more common in the urologic group (51.5%), while the totally extraperitoneal approach (TEP) was rarely used (2.0%). Over time, the transabdominal preperitoneal approach (TAPP) became the predominant approach in this population (46.5%). CONCLUSION: Inguinal hernia repair in patients with a history of urologic surgery is safe and effective, with postoperative outcomes comparable to those in patients without such a history. Despite the increased technical complexity and longer operative times, minimally invasive approaches can be performed reliably in experienced centers.