Postoperative Pain After Robot-Assisted Laparoscopic Ventral Hernia Repair.

Per Lindström,Åsa Hallqvist Everhov,Gabriel Sandblom,Göran Rietz

doi:10.3389/fsurg.2021.724026

Per Lindström, Åsa Hallqvist Everhov + Show 2 more

Open Access

https://doi.org/10.3389/fsurg.2021.724026

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Abstract

Background: Robot-assisted ventral hernia repair, when performed correctly, may reduce the risk for pain and discomfort in the postoperative period thus enabling shorter hospital stay. The aim of the present study was to evaluate postoperative pain following robot-assisted laparoscopic repair. The approach was selected after an intraoperative decision to complete the repair as: (1). Transabdominal Preperitoneal Repair (TAPP); (2). Trans-Abdominal RetroMuscular (TARM) repair; or (3). Intraperitoneal Onlay Mesh (IPOM) repair depending on anatomical conditions.Methods: Twenty ventral hernia repairs, 8 primary and 12 incisional, were included between 18th Dec 2017 and 11th Nov 2019. There were 8 women, mean age was 60.3 years, and mean diameter of the defect was 3.8 cm. The repairs were performed at Södersjukhuset (Southern General Hospital, Stockholm) using the Da Vinci Si Surgical System®. Sixteen repairs were completed with the TAPP technique, 2 with the TARM technique, and 2 as IPOM repair.Results: Mean hospital stay was 1.05 days. No postoperative infection was seen, and no recurrence was seen at 1 year. At the 30-day follow-up, fifteen patients (75%) rated their pain as zero or pain that was easily ignored, according to the Ventral Hernia Pain Questionnaire. After 1 year no one had pain that was not easily ignored.Conclusion: The present study shows that robot-assisted laparoscopic ventral hernia is feasible and safe. More randomized controlled trials are needed to show that the potential benefits in terms of shorter operation times, earlier discharge, and less postoperative pain motivate the extra costs associated with the robot technique.

Highlights

Ventral hernia, primary as well as incisional, is associated with severe morbidity
Repair of ventral hernia ranges from minor procedures that can be undertaken as day surgery to extremely complex reconstructions
Other approaches have been developed to place the mesh outside the abdominal cavity such as endoscopic Mini- or Less-Open Sublay repair, endoscopic Totally Extraperitoneal Approach (TEA), TransAbdominal PrePeritoneal repair (TAPP), and enhanced-view totally extraperitoneal repair [2,3,4]

Summary

Introduction

Primary as well as incisional, is associated with severe morbidity. Repair of ventral hernia ranges from minor procedures that can be undertaken as day surgery to extremely complex reconstructions. The minimally invasive laparoscopic technique using intraperitoneal onlay mesh is well-established and associated with fewer wound infections, but is sometimes followed by severe postoperative pain. Other approaches have been developed to place the mesh outside the abdominal cavity such as endoscopic Mini- or Less-Open Sublay repair (eMILOS), endoscopic Totally Extraperitoneal Approach (TEA), TransAbdominal PrePeritoneal repair (TAPP), and enhanced-view totally extraperitoneal repair (eTEP) [2,3,4]. These approaches are technically more complicated, but postoperative pain may be less since tension in the abdominal wall along the hernia defect is lower.

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