Erfan Zarrinkhoo, BA, Shirin Towfigh, MD. Beverly Hills Hernia Center
Introduction: Laparoscopic mesh removal after inguinal hernia repair with mesh is considered to be complex and poses risk for very serious complications such as injury to major vessels, peripheral nerves, the bladder, and the spermatic cord. Robotic-assistance may help decrease the risk of these injuries.
Methods: Retrospective review of all patients who underwent inguinal hernia mesh removal via laparoscopic and robotic assisted techniques.
Results: From September 2011 to 2015, 25 mesh removals were performed either laparoscopically or with robotic assistance.
| Laparoscopic | Robotic | P-value | |
|---|---|---|---|
| N | 17 | 8 | |
| Age, average | 48 years | 49 years | NS |
| Sex, male | 65% | 62% | NS |
| BMI, average | 28 kg/m2 | 26 kg/m2 | NS |
| Primary reason for mesh removal: | NS | ||
| Chronic pain | 12 (70%) | 7 (78%) | |
| Recurrence | 5 (30%) | 2 (22%) | |
| Prior repair history: | <0.001 | ||
| Laparoscopic w/mesh | 7 (41%) | 8 (89%) | |
| Open w/mesh | 10 (59%) | 1 (11%) | |
| Vascular injury: | 6 | 0 | <0.001 |
| Epigastric vessels | 4 | 0 | |
| External iliac vessels | 2 | 0 | |
| Nerve injury: | 4 | 1 | NS |
| Spermatic cord injury: | 1 | 0 | NS |
| Bladder injury | 0 | 0 | NS |
| Length of Stay (median, range) | 0 days (0-9) | 0 days (0-3) | NS |
Conclusions: Both laparoscopic and robotic-assisted techniques for mesh removal are considered advanced and should be performed by those who are highly skilled in these techniques and very familiar with the complex anatomy in the pelvis. That said, both techniques should be considered as a viable option for mesh removal in the retroperitoneal field, to reduce postoperative stay and recovery. The robotic-assisted technique may result in lower risk for serious complications, possibly due to better visualization and more refined handling of tissues.