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Standard laparoscopic versus robotic retromuscular ventral hernia repair

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Abstract

Background

Laparoscopic ventral hernia repair (LVHR) demonstrates comparable recurrence rates, but lower incidence of surgical site infection (SSI) than open repair. Delayed complications can occur with intraperitoneal mesh, particularly if a subsequent abdominal operation is required, potentially resulting in bowel injury. Robotic retromuscular ventral hernia repair (RRVHR) allows abdominal wall reconstruction (AWR) and extraperitoneal mesh placement previously only possible with open repair, with the wound morbidity of LVHR.

Methods

All LVHR and RRVHR performed in our institution between June 2013 and May 2015 contained in the Americas Hernia Society Quality Collaborative database were analyzed. Continuous bivariate analysis was performed with Student’s t test. Continuous nonparametric data were compared with Chi-squared test, or Fisher’s exact for small sample sizes. p values <0.05 were considered significant.

Results

We compared 103 LVHR with 53 RRVHR. LVHR patients were older (60.2 vs. 52.9 years; p = 0.001), but demographics were otherwise similar between groups. Hernia width was similar (6.9 vs. 6.5 cm, p = 0.508). Fascial closure was achieved more often with RRVHR (96.2 vs. 50.5 %; p < 0.001) and aided by myofascial release in 43.4 %. Mesh was placed in an intraperitoneal position in 90.3 % of LVHR and extraperitoneal in 96.2 % of RRVHR. RRVHR operative time was longer (245 vs. 122 min, p < 0.001). Narcotic requirement was similar between LVHR and RRVHR (1.8 vs. 1.4 morphine equivalents/h; p = 0.176). Seroma was more common after RRVHR (47.2 vs. 16.5 %, p < 0.001), but SSI was similar (3.8 vs. 1 %, p = 0.592). Median length of stay was shorter after RRVHR (1 vs. 2 days, p = 0.004). Direct hospital cost was similar (LVHR $13,943 vs. RRVHR $19,532; p = 0.07).

Conclusion

RRVHR enables true AWR, with myofascial release to offset tension for midline fascial closure, and obviates the need for intraperitoneal mesh. Perioperative morbidity of RRVHR is comparable to LVHR, with shorter length of stay despite a longer operative time and extensive tissue dissection.

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Authors and Affiliations

  1. Department of Surgery, University of South Carolina School of Medicine Greenville, Greenville Health System, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA

    Jeremy A. Warren, William S. Cobb & Alfredo M. Carbonell

  2. Department of Quality Management, Greenville Health System, Greenville, SC, USA

    Joseph A. Ewing

Authors
  1. Jeremy A. Warren
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  2. William S. Cobb
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  3. Joseph A. Ewing
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  4. Alfredo M. Carbonell
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Corresponding author

Correspondence to Jeremy A. Warren.

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Disclosures

Drs. Warren and Carbonell are speakers for Intuitive Surgical. Drs. Warren, Cobb, and Carbonell are consultants for Ethicon, W.L. Gore, and Maquet Surgical. Joseph Ewing has no financial disclosures.

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Warren, J.A., Cobb, W.S., Ewing, J.A. et al. Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31, 324–332 (2017). https://doi.org/10.1007/s00464-016-4975-x

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