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Robotic ventral hernia repair: a safe and durable approach

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Abstract

Background

Short-term success following robotic-assisted ventral hernia repair (RVHR) is well established; however, data describing outcomes after the first year are limited. In this study, we followed a cohort of patients with an average of 1.8 years of follow-up to demonstrate the durability of this technique and examine risk factors for recurrence.

Methods

A retrospective analysis of RVHR performed by a single surgeon from 2012 to 2016 was done. The technical approach for hernia repair consisted of tension-free primary fascial closure with placement of preperitoneal mesh when possible. The primary end point of hernia recurrence was determined based on physical examination or imaging documented in the medical record. A logistic regression model was used to identify patient risk factors for recurrence.

Results

One hundred and eight RVHRs were performed over 4 years. Mean age was 52.72 ± 13.61 years, BMI was 33.07 ± 7.82 kg/m2, and hernia defect size was 70.1 ± 86.3 cm2. In terms of patient characteristics, 17.6% of patients were diabetic, 13.9% were smokers preoperatively, 72.2% were ASA class 3 or higher, and 29.6% had prior VHR. Primary fascial closure was achieved in all RVHRs, with 23.1% requiring component separation. Mesh was used in 97.2% of patients: 79.5% had preperitoneal mesh and 17.6% had intraperitoneal onlay mesh. Ninety-eight percent of patients had long-term follow-up at a mean of 625.6 days. Recurrence rate was 12%, with one recurrence attributed to an inguinal hernia fixed concurrently with a midline defect. There were no statistically significant differences in gender, age, BMI, ASA class, incidence of diabetes, smoking status, or number of previous hernia repairs. Hernia defect size and perioperative complications including SSO, ileus, obstruction, or any other medical complication were not predictive of recurrence. Technical approach did not affect outcomes.

Conclusion

RVHR is safe and durable with a low recurrence rate at a mean of 21 months postoperatively. Patient characteristics or type of repair were not predictive of recurrence.

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References

  1. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183

    Article  CAS  Google Scholar 

  2. Gossetti F, D’Amore L, Ceci F, Grimaldi MR, Negro P (2017) Abdominal wall reconstruction (AWR): the need to identify the hospital units and referral centers entitled to perform it. Updates Surg 69(3):289–290

    Article  Google Scholar 

  3. Khorgami Z, Hui BY, Mushtaq N, Chow GS, Sclabas GM (2019) Predictors of mortality after elective ventral hernia repair: an analysis of national inpatient sample. Hernia 23(5):979–985

    Article  Google Scholar 

  4. Coakley KM, Sims SM, Prasad T, Lincourt AE, Augenstein VA, Sing RF, Heniford BT, Colavita PD (2017) A nationwide evaluation of robotic ventral hernia surgery. Am J Surg 214(6):1158–1163

    Article  Google Scholar 

  5. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13(5):545–554

    Article  CAS  Google Scholar 

  6. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716

    Article  Google Scholar 

  7. Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair. Surg Endosc Other Interv Tech 17(1):123–128

    Article  CAS  Google Scholar 

  8. Liang MK, Berger RL, Li LT, Davila JA, Hicks SC, Kao LS (2013) Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surg 148(11):1043–1048

    Article  Google Scholar 

  9. Nardi M Jr, Millo P, Contul RB, Lorusso R, Usai A, Grivon M, Persico F, Ponte E, Bocchia P, Razzi S (2017) Laparoscopic ventral hernia repair with composite mesh: analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg 40:38–44

    Article  Google Scholar 

  10. Eker HH, Hansson BM, Buunen M, Janssen IM, Pierik RE, Hop WC, Bonjer HJ, Jeekel J, Lange JF (2013) Laparoscopic vs open incisional hernia repair: a randomized clinical trial. JAMA Surg 148(3):259–263

    Article  Google Scholar 

  11. Berger D, Bientzle M, Müller A (2002) Postoperative complications after laparoscopic incisional hernia repair. Surg Endosc Other Interv Tech 16(12):1720–1723

    Article  CAS  Google Scholar 

  12. Gonzalez A, Escobar E, Romero R, Walker G, Mejias J, Gallas M, Dickens E, Johnson CJ, Rabaza J, Kudsi OY (2017) Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc 31(3):1342–1349

    Article  Google Scholar 

  13. Altieri MS, Yang J, Xu J, Talamini M, Pryor A, Telem DA (2018) Outcomes after robotic ventral hernia repair: a study of 21,565 patients in the state of New York. Am Surg 84(6):902–908

    Article  Google Scholar 

  14. Martin-del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2018) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32(2):840–845

    Article  Google Scholar 

  15. Oviedo RJ, Robertson JC, Desai AS (2017) Robotic ventral hernia repair and endoscopic component separation: outcomes. J Soc Laparoendosc Surg 21(3):1–6

    Article  Google Scholar 

  16. Belyansky I, Zahiri HR, Sanford Z, Weltz AS, Park A (2018) Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair. Hernia 22(5):837–847

    Article  CAS  Google Scholar 

  17. Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L (2017) Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 31(3):1275–1279

    Article  Google Scholar 

  18. Orthopoulos G, Kudsi OY (2018) Feasibility of robotic-assisted transabdominal preperitoneal ventral hernia repair. J Laparoendosc Adv Surg Tech 28(4):434–438

    Article  Google Scholar 

  19. Kudsi OY, Paluvoi N, Bhurtel P, McCabe Z, El-Jabri R (2015) Robotic repair of ventral hernias: preliminary findings of a case series of 106 consecutive cases. Am J Robot Surg 2(1):22–26

    Article  Google Scholar 

  20. Bittner JG, Alrefai S, Vy M, Mabe M, Del Prado PA, Clingempeel NL (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32(2):727–734

    Article  Google Scholar 

  21. Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21(3), 378–86.

  22. Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Trans-cutaneous closure of central defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37(1):42–51

    Article  Google Scholar 

  23. Vermeulen J, Alwayn I, Stassen LP (2003) Prolonged abdominal wall pain caused by transfascial sutures used in the laparoscopic repair of incisional hernia. Surg Endosc Other Interv Tech 17(9):1497

    Article  CAS  Google Scholar 

  24. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578

    Article  Google Scholar 

  25. Prasad P, Tantia O, Patle NM, Khanna S, Sen B (2011) Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair. J Laparoendosc Adv Surg Tech 21(6):477–483

    Article  Google Scholar 

  26. Bencini L, Sanchez LJ, Bernini M, Miranda E, Farsi M, Boffi B, Moretti R (2009) Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutaneous Tech 19(2):128–132

    Article  Google Scholar 

  27. Heniford BT, Ross SW, Wormer BA, Walters AL, Lincourt AE, Colavita PD, Kercher KW, Augenstein VA (2018) Preperitoneal ventral hernia repair: a decade long prospective observational study with analysis of 1023 patient outcomes. Ann Surg. https://doi.org/10.1097/SLA.0000000000002966

    Article  PubMed  Google Scholar 

  28. Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46

    Article  CAS  Google Scholar 

  29. Tsereteli Z, Pryor BA, Heniford BT, Park A, Voeller G, Ramshaw BJ (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12(3):233–238

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Albany Medical Center, Albany, NY, USA

    M. E. Sharbaugh, P. B. Patel, J. A. Zaman, A. Ata, P. Feustel & T. P. Singh

  2. Boston College, Boston, MA, USA

    K. Singh

  3. Department of General Surgery, Northern Light Health, 489 State Street, Bangor, ME, USA

    M. E. Sharbaugh

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  1. M. E. Sharbaugh
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  2. P. B. Patel
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  3. J. A. Zaman
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This study was not funded. The authors have no conflict of interest to report.

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Ethical approval from the institutional review board was not required for the study.

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Sharbaugh, M.E., Patel, P.B., Zaman, J.A. et al. Robotic ventral hernia repair: a safe and durable approach. Hernia 25, 305–312 (2021). https://doi.org/10.1007/s10029-019-02074-9

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