Zachary Sanford, MD, Adam S Weltz, Igor Belyansky, MD. Department of Surgery, Anne Arundel Medical Center
Introduction: The use of mesh fixation devices has become a subject of increasing debate in the minimally invasive surgical community, with recent data suggesting mesh fixation devices do not afford significant intraoperative and postoperative benefits in surgical outcomes. This relationship has not been investigated with regards to robotic transversus abdominis release (RTAR) for the repair of abdominal wall defects. We report our analysis of perioperative outcomes in RTAR candidates in whom fibrin glue was both used and spared during abdominal wall reconstruction.
Methods: Retrospective review of a prospectively maintained hernia patient database was conducted identifying individuals who received either fibrin glue or no fixation during abdominal wall reconstruction via the RTAR technique from August 2015 to June 2017 at a single high volume hernia center. Perioperative data and postoperative outcomes between the two groups are presented with statistical analysis for comparison and quality of life measures assessed using the Carolina Comfort Scale.
Results: Of the 30 patients identified, 21 underwent RTAR with the use of fibrin glue for mesh fixation (RTARG) and 9 underwent RTAR without the aid of any mesh fixation device (RTARNG) with no past medical history significant for hernia recurrence. The RTARG cohort had a mean BMI, defect area, mesh area, and operative time of 32.1, 197 cm2, 844 cm2 and 222 minutes, respectively, compared to 32.1, 139 cm2, 898 cm2, and 287 minutes in the RTARNG group. All cases utilized medium weight macroporous polypropylene synthetic implantable mesh materials in both the RTARG and RTARNG subgroups. There were no reported postoperative complications, including no development of hematoma, seroma, or surgical site infections. Hernia recurrence was not identified in either the RTARG or RTARNG cohorts through a mean follow up of 220 days (7 months). There were no statistically significant differences in postoperative outcomes.
Conclusion: Our series review suggests that the use of fibrin glue may not afford significant benefits compared to the use of no mesh fixation with the RTAR technique in the hands of an experienced surgeon. Additional expense associated with fibrin sealant may be unnecessary.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88328
Program Number: P001
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster