Rodolfo Oviedo, MD, FACS, Jarrod Robertson. Florida State University College of Medicine
With the use of robotic assisted surgical technology combined with endoscopic component separation, it is possible to reduce recurrence and complication rates, and allow for immediate intervention in obese patients, in ventral/umbilical/incisional hernia repair by using the following techniques: robotic hernia repair with mesh, with endoscopic component separation. The repair of anterior abdominal wall defects is well documented in the literature. Regardless of the use of open or laparoscopic repair, it is fraught with high recurrence rates when performed in obese patients. By using this combined technique, ventral/umbilical/incisional hernia repair can be done safely on obese patients and result in excellent outcomes.
We conducted a retrospective chart review of ventral/incisional/umbilical hernia cases performed at a small community hospital by a single surgeon from March of 2014 through August of 2016, with statistical analysis of the following endpoints: recurrences, operative time (broken down into: total operative time, docking time, console time), conversion rates (to open surgery), 30 day morbidity and mortality, hospital readmissions and ED visits, SSI's, SSO's. Patients chosen for the study were those performed by the surgeon during this time period that had a BMI >30. Patients were followed postoperatively for a minimum of 3 months, range (3-32 months).
Our study group consisted of 30 ventral/incisional/umbilical hernia repairs. The mean BMI for this group was 37.04 (Range 30.3 – 80.1). The mean console time was 104.5 minutes. There was one complication in this group due to a port site hernia, as well as one SSO at a port site. One recurrence occurred in this group (3.33%). The average length of stay was 1.1 days (range 0-3). All cases were completed robotically.
Robotic laparoscopic repair of abdominal wall defects offers significant advantages. Allowing for easier primary defect closure, robotic ventral/incisional/umbilical hernia repair results in improved outcomes. This technique also results in decreased pain because of the avoidance of trans-fascial sutures. We have shown that this approach combining robotic assisted hernia repair with mesh and endoscopic component separation is an effective intervention in obese patients. This is a patient population with significant rates of recurrences with this procedure. The technique described in this study has shown superior recurrence rates of 3.33% to date. With this technique, it is not only safe to operate on an obese patient population, but recurrence rates are at or below those for the general population and thus patients can be operated on immediately with excellent outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79827
Program Number: P048
Presentation Session: Poster (Non CME)
Presentation Type: Poster
