Jeremy A Warren, MD1, Marcia Alayon-Rosario, MD2, Joseph A Ewing, PhD2, Alfredo M Carbonell, DO1. 1University of South Carolina School of Medicine Greenville, 2Greenville Health System
Robotic technology facilitates reproduction of complex abdominal wall reconstruction with retromuscular placement of prosthesis in a minimally invasive fashion. A transabdominal approach is typically used, often using additional myofascial release in the form of transversus abdominis release (TAR). However, this approach may unnecessarily employ TAR for smaller hernia defects that would not require TAR in an open repair. Use of an extended totally extraperitoneal (eTEP) approach mitigates the overutilization of TAR.
Methods: Prospective, surgeon entered data in the Americas Hernia Society Quality Collaborative (AHSQC) was used to identify all robotic retromuscular ventral hernia repairs (rRMVHR) performed at our institution between October 2013 and September 2018. Patients repaired with the standard transabdominal technique were compared to eTEP. Demographic, operative and outcomes data were compared. Primary endpoints were hospital length of stay (LOS)and use of TAR. Analysis was performed with Chi-square test using R Statistical Software.
Results: Of 195 total rRMVHR were performed, of which 51 were eTEP and 144 transabdominal. Mean age was higher in the eTEP group (60.8 vs 55.7 years; p<0.001), but other comorbidities were no different between groups. Hernia width was smaller for eTEP (median 6cm vs 8cm; p=0.042). There was no difference in surgical site infection (0 vs 2.1%), surgical site occurrence (25.5 vs 39.6%), or those requiring procedural intervention (3.9 vs 4.2%) between eTEP and transabdominal rRMVHR. LOS was significantly shorter with eTEP (median 0 vs 1 day; p<0.001). Use of TAR was significantly reduced with eTEP (13.7 vs 67.4%; p<0.001).
Conclusion: Robotic eTEP repair represents an evolution of rRMVHR that more closely approximates open repair and use of TAR. The eTEP also reduces LOS, with most patients discharged on the day of surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95541
Program Number: P572
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster