Robotic-Assisted Totally Extraperitoneal (eTEP) Hernia Repair with a Suprapubic Approach for Umbilical and Epigastric Hernias: A Retrospective Study

Abstract

Abstract Background In the treatment of umbilical and epigastric hernias, during the last years were developed robotic-assisted techniques to avoid intraperitoneal mesh placement. Robotic-assisted transabdominal preperitoneal (eTAPP) and totally extraperitoneal (eTEP) were described and studies reported that both techniques were safe and achieved optimal results. However, no evidence is reported regarding the best technique. Aims The aim of our study was to assess the safety and effectiveness of the robotic-assisted eTEP compared to eTAPP with suprapubic trocar insertion to treat umbilical and epigastric hernias. Methods We selected from a prospectively maintained database patients who underwent robotic-assisted umbilical and epigastric hernia repair with a suprapubic approach, either eTEP or eTAPP. We retrieved clinical and follow-up data and a statistical analysis was carried out. Results During the study period, 53 patients were included. The mean age was 59.0 ± 13.9 years, 45 patients (84.9%) were male and the mean BMI was 28.0 ± 5.9 kg/m2. Most hernias were umbilical (81.1%) and primary (83.0%). Operative time was slightly shorter for eTEP than eTAPP (106 ± 43 min vs. 126 ± 74 min, p=0.232). No intraoperative complications occurred. Postoperatively, only a case of bleeding and a seroma were recorded. The length of follow-up was 11.3 ± 6.4 months in the eTEP group vs. 20.5 ± 9.7 months in the eTAPP group and no case of recurrence, chronic pain, or significant dysesthesia was recorded. Conclusions In our study, we found that the eTEP approach to treat epigastric and umbilical hernias was safe and feasible and achieved excellent perioperative and follow-up results. The outcomes were similar to patients undergoing the eTAPP approach, but with the advantages of a shorter operative time and not entering the peritoneum.