Incidence and outcomes of ventral hernia repair after robotic retropubic prostatectomy: A retrospective cohort of 570 consecutive cases

Abstract

BackgroundRobotic retropubic prostatectomy (RRP) has become one of the most commonly performed robotic procedures in the United States. Ventral hernia (VH) has been increasingly recognized as an important complication after laparoscopic procedures, in general. However, data related to VH after robotic procedures is relatively scarce, especially after RRP. With increasing popularity of RRP, the purpose of this study was to look at the incidence of VH and outcomes of ventral hernia repair (VHR) after RRP. MethodsAll patients who underwent RRP at a single institution between January 2012 and June 2014 were studied retrospectively using electronic medical records. ResultsA total of 570 patients underwent RRP, of which 33 (5.8%) developed VH during the study period. Fourteen (42%) patients were obese and five (15%) had diabetes. One patient (3%) had a surgical site infection after RRP and two (6%) patients were on immunomodulators/steroids. Median duration to develop VH after RRP was 12 (1–25) months. Out of the 33 patients with VH, ten (33%) underwent VHR; five laparoscopic and five open. Median size of hernia defect and mesh used was 25 (1–144) cm2 and 181 (15–285) cm2, respectively. Median length of hospital stay and follow up was 0 (0–4) days and 12 (1–14) months, respectively. One patient who had initial VHR done at an outside institution had a recurrence. Thirty-two (97%) patients were alive at their last follow up. One patient died secondary to progression of prostate cancer. There was no significant 30 day morbidity (surgical site infection, fascial dehiscence, pneumonia, acute kidney injury, myocardial infarction). Of patients who decided non-operative management of VH (n = 23, 67%), none developed a complication requiring emergent surgical intervention. ConclusionThe incidence of VH after RRP is likely underreported in prior studies. Repair, either laparoscopic or open, is safe and effective in experienced hands. Patients who decide on watchful waiting can be followed with minimal risk of incarceration/strangulation. Further studies are needed to analyze the extraction techniques after RRP and correlate with incidence of VH.