Alex Addo, MD1, Richard Lu, MD1, Stephanie Parlacoski, BA1, Zachary Ewart, MD2, Andrew Broda, BS1, Reza Zahiri, DO1, Igor Belyansky, MD, FACS1. 1Anne Arundel Medical Center, 2WellSpan Health
Background: Since the publication by Dr. Jorge Daes of enhanced-view totally extraperitoneal (eTEP) technique in 2012 describing laparoscopic access to the retrorectus space, there has been continued innovation regarding minimally invasive hernia surgery. By combining the eTEP technique with Rives-Stoppa ventral hernia repair, we developed a novel minimally invasive approach allowing repair of larger and more extensive ventral hernias, correction of midline contour abnormalities, and restoration of the linea alba. We previously published data reviewing 30-day patient outcomes. The purpose of this study is to review outcomes beyond those 30 days and compare laparoscopic to robotic approach.
Methods: A retrospective review was conducted of patients who underwent laparoscopic eTEP (Lap-eRS) and robotic-assisted eTEP (reRS) Rives-Stoppa repairs between September 2015 and May 2018 at our institution. We analyzed preoperative demographics, intraoperative data, and postoperative outcomes.
Results: The review identified 206 patients (Lap-eRS 120 vs reRS 86). The groups were comparable (p>0.05) in gender distribution (47.6%vs53% male) and mean age (53.2vs50.8 years) but different (p<0.05) in mean BMI (31.3vs34.4kg/m2) and ASA class (2.1vs2.4). The reRS group had a higher defect size compared to the Lap-eRS group (7.1 vs 5.5 cm, p<0.05). Intraoperatively, reRS group had a longer operative time (174.7 vs 120.4 minutes, p<0.05), mesh area was similar in both groups (526.2 vs 507.5cm2). Mean length of stay (2.3vs0.4 days), mean length of drain placement (5.3vs5.7days) and rate of return to the operating room (2.5% vs 2.3%) were analogous between Lap-eRS and reRS (p>0.05). Total hospital charge was significantly higher in the robotic group compared to laparoscopic group ($9,037 vs.$6,775,p<0.05). Patients in both groups (Lap-eRS vs reRS) were followed for comparable times (4.9 vs 3.7 months, p>0.05) and showed similar recurrence rates (0.8% vs 1.2%, p>0.05).
Conclusion: Morbidly obese patients with more complex abdominal wall defects were more likely to undergo a reRS. This may reflect our current practice to reserve robotic-assistance for cases with higher BMI and larger hernia defect sizes. The significantly longer operative time and higher hospital cost with the reRS group may be due to these factors. Both groups demonstrated lower trends in perioperative morbidity rates. This suggests MIS (robotic and laparoscopic) eTEP Rives-Stoppa repair, although novel, is associated with favorable perioperative outcomes and low recurrence rate. Further follow-up is required to better characterize the rate of unique complications and long-term recurrence rate associated with this technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95657
Program Number: S030
Presentation Session: Complex Abdominal Wall Hernia
Presentation Type: Podium