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Early Outcomes of Robotic Inguinal Hernia Repair in Obese Patients: A Multi-Institutional, Retrospective study

Ramachandra Kolachalam, MD1, Reza A Gamagami, MD, FACS2, Eugene O Dickens, MD, FACS3, Lawrence D’Amico, MD4, Christopher J Richardson, DO, FACOS5, Anthony Gonzalez, MD, FACS, FASMBS6, Jorge Rabaza, MD, FACS6. 1Providence Park Hospital, 2Silver Cross Hospital, 3Utica Park Clinic, 4Trumbull Memorial Hospital, 5Rochester General Hospital, 6Baptist Health South Florida

Purpose: The purpose of this study is to analyze the intraoperative and early post-operative outcomes of robotic-assisted (da Vinci®) inguinal hernia repairs in obese (BMI ≥ 30) patients.

Design: A retrospective chart review was conducted across 7 surgeons from 6 different sites, who contributed their early robotic-assisted inguinal cases and experienced open repair cases. A total of 1247 subjects were uniformly collected with reported BMI: 596 open cases and 651 robotic-assisted repair cases. Within the open cohort, n=482 (80.9%) had BMI <30 and n= 114 (19.2%) had BMI ≥30; in the robotic cohort, n=504 (77.4%) had BMI <30 and n=148 (22.6%) had BMI ≥ 30. Demographics, operative characteristics and complications (intraoperative, post-operative through discharge to 30 days) for the open and robotic-assisted cohorts were compared.

Results: In the robotic cohort for obese (BMI ≥30) subjects, the operative times (87.9 ± 35.6 min vs 77.3 ± 30.0 min, p=0.003), and conversions (n=3 (2.01%) vs n=3 (0.6%), p = NS)) were predictably greater compared with the robotic cohort with BMI less than 30. Additionally, the cohort for obese subjects had more concomitant procedures, but this was not significantly different (23.3% vs 29.7%, p = NS). No significant differences were observed in the intraoperative complications, post-operative complications, or related readmissions/reoperations between patients in the robotic-assisted cohort with and without obesity.

When compared with patients with BMI greater than 30 in the open cohort, operative times were longer (49.9 ± 21.9 min vs 87.9 ± 35.6 min, p <0.0001) however inpatients had a shorter length of stay in the robotic cohort (n=14, 1.7 ± 0.8 days vs n=12, 3.7 ± 3.1 days, p = 0.041). No significant differences were observed in the intraoperative complications, post-operative complications (prior to discharge) or related readmissions, however there was a lower rate of post-operative complications from discharge to 30 days (2.7% vs 11.4%, p=0.005). Furthermore, a lower rate of related reoperations in robotic cohorts for subjects with BMI ≥ 30 was observed when compared to the open cohort (0% vs 3.5%, p=0.035).

Conclusion: Patients with and without obesity have similar outcomes after robotic inguinal hernia repair. When compared with open repairs, obese (BMI ≥30) patients have a lower rate of post-operative complications (discharge to 30 days) and a lower rate of reoperations related to the inguinal repair, which could lead to lower healthcare costs and a more satisfactory patient journey.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80357

Program Number: S106

Presentation Session: Hernias: Inguinal and Robotics

Presentation Type: Podium

65

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