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Robotic ventral hernia repair in morbidly obese patients: perioperative and mid-term outcomes

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Abstract

Background

Obesity is a growing epidemic and it has been found to be an independent risk factor for a multitude of perioperative complications. We describe our experience with morbidly obese patients who underwent robotic ventral hernia repair (RVHR), examining factors affecting perioperative and mid-term outcomes.

Methods

From a prospectively maintained database, all morbid obese (BMI ≥ 40 kg/m2) patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and the mid-term follow-up. Complications were assessed with validated grading systems and index. Univariate analyses and multivariate logistic regression analysis were performed to determine the factors associated with the development of any complication. Kaplan–Meier’s time-to-event analysis was performed to calculate freedom-of-recurrence.

Results

Fifty patients with median BMI 42.9 kg/m2 were included. The median last pain score before leaving PACU was 4. The mean LOS of all cohorts was 0.32 day. The postoperative complication rate was 46%. The most frequent complication was persistent pain/discomfort (32%) in early postoperative period. Minor complications (Clavien–Dindo grade-I and II) were seen in 40% of patients while major complications (Clavien–Dindo grade-III and IV) were seen in 6%. The maximum comprehensive complication index® score was 42.9. In regression analysis, BMI, adhesiolysis, intraperitoneal mesh placement, and off-console time were found to be significantly associated with postoperative complications. Mean follow-up was 22.7 months. Hernia recurrence was seen in 2% and the mean freedom-of-recurrence was 57.4 months (95% CI 54.6–60.2).

Conclusions

To our best knowledge, this study is the first to present outcomes of morbidly obese patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in morbid obesity with a low recurrence rate as well as a long freedom-of-recurrence time. Further studies are needed to better elucidate the role of robotic surgery in morbidly obese patients.

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References

  1. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781. https://doi.org/10.1002/14651858.cd007781.pub2

    Article  Google Scholar 

  2. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124(4):816–821. https://doi.org/10.1067/msy.1998.92102 (discussion 821–812)

    Article  CAS  PubMed  Google Scholar 

  3. Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003) Laparoscopic versus open umbilical hernia repair. JSLS 7(4):323

    PubMed  PubMed Central  Google Scholar 

  4. Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic versus open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21(3):378–386

    Article  PubMed  Google Scholar 

  5. Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 288:1–8

    Google Scholar 

  6. Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234. https://doi.org/10.1146/annurev.med.49.1.215

    Article  CAS  PubMed  Google Scholar 

  7. Froylich D, Segal M, Weinstein A, Hatib K, Shiloni E, Hazzan D (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30(2):670–675. https://doi.org/10.1007/s00464-015-4258-y

    Article  PubMed  Google Scholar 

  8. Birgisson G, Park AE, Mastrangelo MJ Jr, Witzke DB, Chu UB (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15(12):1419–1422. https://doi.org/10.1007/s004640080077

    Article  CAS  PubMed  Google Scholar 

  9. Novitsky YW, Cobb WS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141(1):57–61. https://doi.org/10.1001/archsurg.141.1.57

    Article  PubMed  Google Scholar 

  10. 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. https://doi.org/10.1007/s10029-007-0310-8

    Article  CAS  PubMed  Google Scholar 

  11. Tayar C, Karoui M, Cherqui D, Fagniez PL (2007) Robot-assisted laparoscopic mesh repair of incisional hernias with exclusive intracorporeal suturing: a pilot study. Surg Endosc 21(10):1786–1789. https://doi.org/10.1007/s00464-007-9247-3

    Article  CAS  PubMed  Google Scholar 

  12. Oviedo RJ, Robertson JC, Desai AS (2017) Robotic ventral hernia repair and endoscopic component separation: outcomes. JSLS. https://doi.org/10.4293/jsls.2017.00055

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schluender S, Conrad J, Divino CM, Gurland B (2003) Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing. Surg Endosc 17(9):1391–1395. https://doi.org/10.1007/s00464-002-8795-9

    Article  CAS  PubMed  Google Scholar 

  14. Alfalah H, Philippe B, Ghazal F, Jany T, Arnalsteen L, Romon M, Pattou F (2006) Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity. Obes Surg 16(2):147–150. https://doi.org/10.1381/096089206775565104

    Article  PubMed  Google Scholar 

  15. Harr JN, Haskins IN, Amdur RL, Agarwal S, Obias V (2018) The effect of obesity on laparoscopic and robotic-assisted colorectal surgery outcomes: an ACS-NSQIP database analysis. J Robot Surg 12(2):317–323. https://doi.org/10.1007/s11701-017-0736-7

    Article  PubMed  Google Scholar 

  16. Panteleimonitis S, Pickering O, Abbas H, Harper M, Kandala N, Figueiredo N, Qureshi T, Parvaiz A (2018) Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis 33(8):1079–1086. https://doi.org/10.1007/s00384-018-3030-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  19. Petro CC, Novitsky YW (2016) Classification of hernias. In: Novitsky YW (ed) Hernia surgery. Springer, Cham, pp 15–21

  20. Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267. https://doi.org/10.1007/s10029-012-0911-8

    Article  CAS  PubMed  Google Scholar 

  21. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732

    Article  PubMed  Google Scholar 

  22. Raftopoulos I, Courcoulas AP (2007) Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc 21(12):2293–2297. https://doi.org/10.1007/s00464-007-9406-6

    Article  CAS  PubMed  Google Scholar 

  23. Evans KK, Chim H, Patel KM, Salgado CJ, Mardini S (2012) Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias. Am Surg 78(4):388–397

    PubMed  Google Scholar 

  24. Sugiyama G, Chivukula S, Chung PJ, Alfonso A (2015) Robot-assisted transabdominal preperitoneal ventral hernia repair. JSLS. https://doi.org/10.4293/jsls.2015.00092

    Article  PubMed  PubMed Central  Google Scholar 

  25. Allison N, Tieu K, Snyder B, Pigazzi A, Wilson E (2012) Technical feasibility of robot-assisted ventral hernia repair. World J Surg 36(2):447–452. https://doi.org/10.1007/s00268-011-1389-8

    Article  PubMed  Google Scholar 

  26. 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. https://doi.org/10.1166/ajrs.2015.1020

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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. https://doi.org/10.1007/s00464-016-5118-0

    Article  PubMed  Google Scholar 

  28. Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK (2014) Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg 38(12):3097–3104. https://doi.org/10.1007/s00268-014-2722-9

    Article  PubMed  Google Scholar 

  29. LeBlanc K (2004) Laparoscopic incisional and ventral hernia repair: complications—how to avoid and handle. Hernia 8(4):323–331

    Article  CAS  PubMed  Google Scholar 

  30. Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217(6):974–982. https://doi.org/10.1016/j.jamcollsurg.2013.08.003

    Article  PubMed  Google Scholar 

  31. LeBlanc K (2016) Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 20(1):85–99. https://doi.org/10.1007/s10029-015-1399-9

    Article  CAS  PubMed  Google Scholar 

  32. Tulloh B, de Beaux A (2016) Defects and donuts: the importance of the mesh: defect area ratio. Hernia 20(6):893–895

    Article  CAS  PubMed  Google Scholar 

  33. Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P (2017) Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc 31(9):3656–3663

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Elif Gokcal for helping us with this study.

Funding

These authors have no support or funding to report.

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Authors and Affiliations

  1. Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA

    Fahri Gokcal, Sara Morrison & Omar Yusef Kudsi

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  1. Fahri Gokcal
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  2. Sara Morrison
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  3. Omar Yusef Kudsi
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Correspondence to Omar Yusef Kudsi.

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Disclosures

Drs. Gokcal and Morrison have no conflicts of interest or financial ties to disclose. Dr. Kudsi receives teaching course and/or consultancy fees from Intuitive, Bard, Medtronic, Gore, Optecks, Medrobotic, outside the submitted work.

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Gokcal, F., Morrison, S. & Kudsi, O.Y. Robotic ventral hernia repair in morbidly obese patients: perioperative and mid-term outcomes. Surg Endosc 34, 3540–3549 (2020). https://doi.org/10.1007/s00464-019-07142-w

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