Robotic Ventral Hernia Repair and Concomitant Procedures: Mid-term Outcomes and Risk Factors Associated With Postoperative Complications.

Abstract

Ventral hernia remains as one of the most performed procedures worldwide. With the aging of the population and increasing comorbidities, it is common for ventral hernia to coexist with other pathologies that require surgery. Patients may opt for concomitant repairs while undergoing ventral hernia surgery. Therefore, the purpose of this study is to investigate the clinical outcomes of robotic ventral hernia repair (RVHR) in patients undergoing concomitant repairs. Patients who underwent RVHR with concomitant repairs over a period of 9 years were included in this retrospective study. Pre, intra, and postoperative variables including the patient's demographics, hernia characteristics, complications, and hernia recurrence were reported. Univariate analysis was performed to evaluate potential variables associated with increased risk of postoperative complications. A total of 109 (33% females) patients were included in this study. Mean age and body mass index were 59.9±12.7 years and 30.5±5.7 kg/m2, respectively. Concomitant repairs were mostly abdominal wall procedures (inguinal hernia repairs, 88.1%). Other procedures included nonabdominal wall surgeries. Incisional hernia repairs were higher than primary repairs (55% vs 45%, respectively). Median operative time and hospital length of stay were 145 min (102 to 245) and 1 day (0 to 1), respectively. Mean postoperative follow-up was 39.2 (4.1 to 93.6) months. In total, 24 patients had postoperative complications, out of which 16 (14.7%) were Clavien-Dindo grade I and II, and 10 (9.2%) were grade III and IV. Nine patients had surgical site events, and two recurrences were recorded. Postoperative complications were associated with incisional hernias [Odds ratio (OR)=8.4; P=0.003; 95% CI=2.092-33.423], nonabdominal wall concomitant procedures (OR=5.9; P=0.013; 95% CI=1.453-24.451), and history of wound infection (OR=3.473; P=0.047; 95% CI=1.016-11.872). This is the first study to report outcomes of concomitant repairs with RVHR, with notable Clavien-Dindo grade III and IV complications of 9%. Incisional hernia repairs, nonabdominal wall procedures, and a history of wound infection were risk factors for postoperative complications.