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Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair

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Abstract

Background

Transversus abdominis release (TAR) is a safe, effective strategy to repair complex ventral incisional hernia (VIH); however, open TAR (o-TAR) often necessitates prolonged hospitalization. Robot-assisted TAR (r-TAR) may benefit short-term outcomes and shorten convalescence. This study compares 90-day outcomes of o-TAR and r-TAR for VIH repair.

Methods

A single-center, retrospective review of patients who underwent o-TAR or r-TAR for VIH from 2015 to 2016 was conducted. Patient and hernia characteristics, operative data, and 90-day outcomes were compared. The primary outcome was hospital length of stay, and secondary metrics were morbidity, surgical site events, and readmission.

Results

Overall, 102 patients were identified (76 o-TAR and 26 r-TAR). Patients were comparable regarding age, gender, body mass index, and the presence of co-morbidities. Diabetes was more common in the open group (22.3 vs. 0%, P = 0.01). Most VIH defects were midline (89.5 vs. 83%, P = 0.47) and recurrent (52.6 vs. 58.3%, P = 0.65). Hernia characteristics were similar regarding mean defect size (260 ± 209 vs. 235 ± 107 cm2, P = 0.55), mesh removal, and type/size mesh implanted. Average operative time was longer in the r-TAR cohort (287 ± 121 vs. 365 ± 78 min, P < 0.01) despite most receiving mesh fixation with fibrin sealant alone (18.4 vs. 91.7%, P < 0.01). r-TAR trended toward lower morbidity (39.2 vs. 19.2%, P = 0.09), less severe complications, and similar rates of surgical site events and readmission (6.6 vs. 7.7%, P = 1.00). In addition, r-TAR resulted in a significantly shorter median hospital length of stay compared to o-TAR (6 days, 95% CI 5.9–8.3 vs. 3 days, 95% CI 3.2–4.3).

Conclusions

In select patients, the robotic surgical platform facilitates a safe, minimally invasive approach to complex abdominal wall reconstruction, specifically TAR. Robot-assisted TAR for VIH offers the short-term benefits of low morbidity and decreased hospital length of stay compared to open TAR.

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Disclosures

James G. Bittner has received speaking/teaching fees, consulting fees, and research grants from CR Bard (Davol) and Cook Medical, research grants from EnteroMedics, and speaking/teaching and consulting fees from Intuitive Surgical, all outside the submitted work. Sameer Alrefai, Michelle Vy, Micah Mabe, Paul A.R. Del Prado, and Natasha L. Clingempeel have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    James G. Bittner IV

  2. Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA

    James G. Bittner IV, Sameer Alrefai, Michelle Vy, Micah Mabe & Natasha L. Clingempeel

  3. Department of Surgery, Division of General Surgery, Maricopa Medical Center, Phoenix, AZ, USA

    Paul A. R. Del Prado

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  1. James G. Bittner IV
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  2. Sameer Alrefai
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  6. Natasha L. Clingempeel
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Correspondence to James G. Bittner IV.

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Bittner, J.G., Alrefai, S., Vy, M. et al. Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32, 727–734 (2018). https://doi.org/10.1007/s00464-017-5729-0

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  • DOI: https://doi.org/10.1007/s00464-017-5729-0

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