Robotic-Assisted Abdominal Wall Hernia Repair Does not Decrease Peri-operative Pain When Compared to Laparoscopic Repair

Maureen D Moore, MD, Katherine D Gray, MD, Suraj Panjwani, MBBS, Aaron Burshtein, Joshua Burshtein, Thomas J Fahey III, Gregory Dakin, MD, Alfons Pomp, MD, Cheguevara Afaneh, MD, Rasa Zarnegar, MD. New York Presbyterian Hospital-Weill Cornell Medical Center

INTRODUCTION: When compared to open abdominal ventral hernia repair, laparoscopic repair results in decreased pain and complication rates. We aimed to determine the perioperative pain scores and outcomes when comparing robotic-assisted abdominal wall hernia repair with fascial closure to traditional laparoscopic-assisted approach with open fascial closure.

METHODS: We retrospectively reviewed 173 consecutive patients who underwent primary laparoscopic-assisted ventral hernia repair (LVHR), primary robotic-assisted ventral hernia repair (RVHR), laparoscopic-assisted incisional hernia repair (LIHR) or robotic-assisted incisional hernia repair (RIHR) between 2014-2016. Both primary repair of the defect as well as placement of an underlay mesh was performed. Robotic-assisted hernia repairs involve robotically suturing the mesh in place, while the laparoscopic approach involves tacking the mesh in place. Patient characteristics, operative details, post-operative complications, post-operative pain scores and medication requirements were collected and analyzed. Primary end points were cumulative opioid use at 6, 12, 18, 24 and 48 hours post-operatively and pain scores recorded in six-hour intervals up to 18 hours post-operatively. Secondary end-points were post-operative complications and length of stay (LOS).

RESULTS: Patient demographics and clinical characteristics in the laparoscopic (n = 89) versus robotic groups (n = 84) were comparable except for Charlson Index (p=0.04) (Table 1). The mean operative time was shorter in primary LVHR versus primary RVHR (68 ± 21 mins vs. 107 ± 29 mins; respectively p=<0.0001), however there was no statistical difference when comparing LIHR versus RIHR. There were no significant differences in EBL, conversion rates and post-operative complication rates among groups. LIHR had significantly smaller hernia defect sizes (p=0.04) but used larger mesh sizes when compared to RIHR (P=<0.001). The LVHR group had a shorter LOS (p=0.03). The LIHR group had significantly lower pain scores throughout the first 6 hours post-operatively (p=0.03). There was a significant difference in opioid use between LVHR vs. RVHR (p=0.001) and LIHR vs. RIHR (p=0.005) from 6-12 hours postoperatively. Cumulatively, patients in the LIHR group required less opioids than RIHR (p=0.02). There was no significant difference in pain scores at any time point among the groups after 6 hours postoperatively (p > 0.05) (Table 2).

CONCLUSION: Robotic-assisted ventral hernia repair with mesh is a safe and feasible approach; however, laparoscopic ventral hernia repair may confer less early post-operative pain with resultant decreased opioid use especially after an incisional hernia repair.