Ibrahim Azer, MD, Thomas Shaknovsky, DO, Frederick Sabido, MD, FACS. Richmond university medical center ,staten island ,New York
INTRODUCTION: Robotic ventral hernia repair with a Bio-resorbable mesh has an equal or lower recurrence rate compared with permanent mesh at 18 months with no life time risk of mesh infection. Incidences of mesh-related infection after hernia repair of up to 8% have been reported . The rate of infection is influenced considerably by underlying co-morbidity, and seems to be increased in patients with diabetes, immunosuppression or obesity. Almost a third of patient had their infections diagnosed a year after mesh implant.
METHODS: We retrospectively collected data from our first 100 RVHR during the period of January 2015 to September 2016. All the robotic procedures were performed using the daVinci Si Surgical platform. Primary closure of the fascial defect and excision of hernia sac was performed in all cases. All patients received prophylactic IV antibiotics before surgery. Fixation of the mesh was performed with absorbable intra-corporeal sutures to the peritoneum only using intraperitoneal onlay mesh (IPOM ) method.
RESULTS: Patients were female in 43(43%) and male in 57(57%). Mean age was 54. mean ASA of 2.35. Mean BMI was 43 range (35-55). The following types of ventral hernia were found: incisional 37 (37%), Peri-umbilical 23(23%) , epigastric 29 (29%), multiple fascial defect 11(11%) . Mean surgical time was 86 minutes range (70-107).Mean Console time 42 minutes range (35-53).PACU stay time range (120-175) minutes All Patients were discharge Home Same Day. Mean follow up was 10 months with range (4-18). Urine retention developed in 1 patient (1%) and surgical site infection (SSI) developed in 2 patient (2%) at the robotic trocar site. There was no mesh infection seen so far .No recurrences were seen. No perioperative myocardial infarction (MI), pulmonary embolism (PE) or deep venous thrombosis (DVT) was seen.
CONCLUSIONS: RVHR has the advantages of lower complication and lower recurrence rate. It eliminates the need for drains and narcotics with faster return to normal activity and work with no life time risk of infection due to complete resorption of the mesh after 18 month period.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80337
Program Number: P059
Presentation Session: Poster (Non CME)
Presentation Type: Poster