ANTERIOR PUBIC RING RE-CREATION WITH CADAVERIC BONE TO REPAIR BILATERAL INGUINAL HERNIAS IN THE SETTING OF PROSTATECTOMY AND PUBIC BONE RESECTION

Objectives: A 73-year-old male post prostatectomy, cystectomy and pubic bone resection for prostate cancer presented with symptomatic bilateral inguinal hernias. Pubic bone resection rates having been decreasing but these patients continue to experience hernias. Hernia repair was challenging as there was no scaffolding of bone for the attachment of mesh.

Methods: A transverse incision was made in the lower abdomen across the previous midline scar. After adhesiolysis, the bowel was displaced superiorly and the pubic rami were exposed. Our orthopedic colleagues used cadaveric bone for an allograft reconstruction and open reduction and fixation of the anterior pelvic ring. Placement was confirmed radiographically. A 12x10 cm composite mesh was placed in the pelvis and draped around the rectum. After formation of anterior skin flaps, the fascia was secured to the newly formed pubic bone and metal plates. An 6x6 cm microporous mesh was placed horizontally on the anterior fascia in an only position, split on each end and each side was wrapped around the respective spermatic cords. A drain was placed in the pelvis and the incision was closed in the usual fashion.

Results: The patient tolerated the procedure well. Post operatively, he developed an ileus but was subsequently discharged after 6 days. The bilateral inguinal hernias remained reduced and mesh remained intact.

Conclusion: Using cadaveric bone to re-create the anterior pelvic ring provides adequate scaffolding for the anterior fascia for mesh repair of bilateral inguinal hernia repairs.