Wound Complications After Inguinal Hernia Repair, Has Robotic Surgery Improved Outcomes?

Carla N Holcomb, MD, MSPH¹, Li-Ching Huang², Savannah Renshaw¹, Susan Maurer, MD¹, Noah Switzer, MD¹, Michael Meara, MD¹, Courtney Collins, MD¹, Vimal Narula, MD¹, Benjamin Poulose, MD¹. ¹Ohio State University Medical Center, ²University of Vanderbilt

Introduction: Minimally invasive inguinal hernia surgery has been associated with lower surgical site infections compared to open surgery. However, there is speculation that the preperitoneal approach may lead to higher rates of seroma formation.  Robotic assisted inguinal surgery has become increasingly popular yet it is unclear if this approach is an improvement on the standard open Lichtenstein repair in terms of surgical site complications.  The purpose of this study was to compare surgical site complication rates after robotic assisted transabdominal preperitoneal repair(rTAPP) of inguinal hernias to open Lichtenstein hernia repair(oIHR). 

Methods: The study consisted of multi-institutional data from patients undergoing elective, non-recurrent inguinal hernia repair with either rTAPP or oIHR in the Americas Hernia Society Quality Collaborative from 2013-2018.  Outcomes of interest included surgical site occurrence (SSO), which is a composite variable of surgical site infection, skin or soft tissue ischemia, wound drainage, seroma, or hematoma. Wilcoxon rank-sum test was used for continuous variables and Pearson chi-square analysis was used for categorical variables.

Results: The study population consisted of 1170 inguinal hernia repairs including 540 rTAPP (46%) and 630 oIHR (54%).  Patients that underwent oIHR were more likely to be older (65 years [55-73 years] vs 60 years[48-70 years], p=0.01) and have higher rates of diabetes mellitus (11% vs 8%), p=0.06) compared to rTAPP.   There was no significant difference between groups regarding hernia size (rTAPP 2.0cm[1.0-5.0cm] vs oIHR 2.0cm[1.6-3.0cm], p=0.84).  Overall SSO rates were low at 2.8%(n=33) and did not significantly differ by rTAPP(2%) vs oIHR(3%), p=0.14.   The most common SSO in both groups was seroma but this was not significantly different in either group(1.6% for rTAPP versus 1.4% for oIHR p=0.17).  There was no significant difference in any postoperative complication (5% vs 5%), hernia recurrence (0.2% vs 0.0%) or 30 day readmission(1% vs 1%) for rTAPP vs oIHR, respectively.