Ventral Hernia Repair Research Articles

Females report worse outcomes than males one year after ventral hernia repair.

To assess sex differences in patient-reported quality of life, pain, and hernia recurrence after adjusting for confounding features of hernia disease in a large national registry one year after ventral hernia repair. Data were analyzed retrospectively from the Abdominal Core Health Quality Collaborative national registry from pre-operatively until one year post-operatively. 3,172 patients undergoing elective ventral hernia repair with 1-year follow-up data were included for analysis after propensity score matching (1:1 match; females: mean [interquartile range] age, 60 [49, 68]; body mass index, 32 [27, 36]; males: age, 60 [52, 68]; 31 [28, 35]. The primary outcome of interest between sexes was the Hernia Related Quality of Life survey (HerQLes), and secondary outcome measures included the Patient-Reported Outcomes Measurement Information System Pain Intensity (PROMIS) short form (3a) score and hernia recurrence. Female sex was associated with worse HerQLes and PROMIS pain 3a scores at 1 year follow up (adjusted mean difference, -2.42, 95% confidence interval (CI) -4.11 to -0.72; p = 0.004; adjusted mean difference, 1.27, 95% CI 0.67 to 1.87; p < 0.001) compared to male sex. Hernia recurrence rates at 1 year were not different between sexes. Females reported worse quality of life and higher levels of pain at 1-year post ventral hernia repair after accounting for age, BMI, hernia width, and baseline quality of life compared to males. There were no differences between females and males with respect to hernia recurrence at 1-year follow-up, and 1 in 5 patients experienced a recurrence at this time point.

Effect of an abdominal binder on postoperative outcomes after ventral hernia repair: a systematic review and meta-analysis of randomized controlled trials.

Abdominal binders consist of a wide compression belt that encircles the abdomen, theoretically supporting the abdominal wall. However, their use after ventral hernia repair is debated. Therefore, this meta-analysis evaluates their efficacy. We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing the effects of abdominal binders after ventral hernia repair. Outcomes included postoperative pain using the visual analog scale (VAS), surgical site infection (SSI), seroma formation and size, general well-being, activity limitation, forced expiratory volume in the first second (FEV1), and a 6-min walk test. Statistical analysis was performed with Review Manager 5.4.1 using a random-effects model. We included five RCTs encompassing 297 patients. Overall analysis showed decreased SSI rates (RR 0.21; 95% CI 0.07 to 0.59; p = 0.003; I2 = 0%) and reduced pain two weeks after surgery (MD -0.89; 95% CI -1.41 to -0.37; p = 0.0008; I2 = 0%) using abdominal binders. For patients undergoing open ventral hernia repair, it also demonstrated reduced SSI, pain four weeks after surgery (MD -0.60; 95% CI -0.88 to -0.32; p < 0.0001; I2 = 66%) and increased 6-min walk test performance four weeks after the procedure (MD 32.78m; 95% CI 15.28 to 50.29m; p = 0.0002; I2 = 0%). Abdominal binders may decrease SSI, postoperative pain, and increase physical condition, particularly in open ventral hernia repair. Further studies are still required to evaluate the role of abdominal binders in minimally invasive techniques.

The effect of clinically significant weight loss prior to open ventral hernia repair.

The study aim was to assess the impact of clinically significant weight loss (CSWL; ≥5% weight reduction) on postoperative complications following abdominal wall reconstruction with the component separation technique (CST). A retrospective review of patients who underwent open ventral hernia repair (VHR) with CST from November 2008 to January 2022 was performed. Cohorts were stratified by presence of CSWL from baseline weight at preoperative consultation. Of 180 total patients, 40 (22.2%) achieved CSWL prior to VHR. Mean age was 59.6 ± 11.2 years. Patients in the CSWL cohort represented a higher average body mass index (BMI) (33.6 vs. 31.7kg/m2, p = 0.076), and were obese more frequently (80.0% vs. 56.4%, p = 0.007). The CSWL cohort had a higher proportion of patients in Ventral Hernia Working Group (VHWG) classification II (82.5% vs. 63.6%) while the non-CSWL cohort had more VHWG classification III/IV (20.0% vs. 10.0%, p = 0.078). Mean follow-up duration was 6.1 ± 13.4 months. Complications, including 30- and 90-day surgical site occurrence (SSO), return to operating room, readmission, and hernia recurrence (CSWL: 5.0% vs. non-CWL 1.4%, p = 0.179), were comparable between cohorts. BMI was an independent predictor of any complication (OR 1.07, p = 0.044) and 90-day SSO (OR 1.10, p = 0.043). Achievement of CSWL prior to open VHR utilizing CST results in similar post-reconstruction outcomes to patients who maintained a comparable BMI at baseline. Higher day-of-surgery BMI was more consequential to postoperative complications than percent weight loss.

Consensus in ERAS protocols for ventral hernia repair: evidence-based recommendations from the ACHQC QI Committee.

Enhanced recovery after surgery (ERAS) protocols are widely used in the post-operative care of hernia patients. Despite their prevalence, an absence of published consensus guidelines creates significant heterogeneity in practices. The aim of this study was to evaluate elements in ERAS protocols utilized in ventral hernia repair from institutions across the United States and provide consensus recommendations for each identified element. Institutional members of the Abdominal Core Health Quality Collaborative (ACHQC) Quality Improvement (QI) committee submitted current ERAS protocols. Items within each protocol were classified as "elements", then assigned a topic. Any topic with ≥ 2 elements from separate institutions were labeled as a "theme," then grouped by stage in the patient care cycle. A brief review of current evidence was provided in addition to a ACHQC QI committee consensus statement. A total of 295 elements from 6 tertiary referral centers specializing in hernia care were compiled into 24 themes and grouped by four separate stages: Pre-Admission Optimization, Pre-Operative Care, Intra-operative Care, and Post-Operative Management. This article represents a multi-institutional review of ERAS protocols for ventral hernia repair and identifies common themes that may provide the framework for a unified ERAS protocol in hernia surgery. Future work may serve to develop societal guidelines defined specifically for enhanced recovery in ventral hernia repair.

Minimally invasive intraperitoneal onlay mesh plus (IPOM +) repair versus enhanced-view totally extraperitoneal (e-TEP) repair for ventral hernias: a systematic review and meta-analysis.

Following concerns regarding an intraperitoneal mesh, newer ventral hernia repair (VHR) approaches focus on placing the mesh outside of the peritoneal cavity. The e-TEP technique used the retromuscular space and is suggested to be associated with decreased postoperative pain compared to IPOM +. This study aims to compare the IPOM + with the e-TEP for VHR. We searched for studies comparing endoscopic IPOM + and e-TEP in PubMed, EMBASE, and Cochrane databases from inception until September 2023. Outcomes were Visual Analog Scale (VAS) after 24 h of surgery and between 7 and 10 days after surgery, operative time, length of stay (LOS), seroma, recurrence, and readmission. RStudio was used for statistical analysis. Heterogeneity was assessed with I2 statistics, with random effect for I2 > 25%. From 149 records, 7 were included, from which 3 were RCTs, 3 were retrospective studies, and 1 was an observational prospective study. 521 patients were included (47% received e-TEP and 53% received IPOM +). 1 study included only robotic surgeries and 6 studies included only laparoscopy. Mean defect width was 3.62 cm ± 0.9 in the e-TEP group and 3.56 cm ± 0.9 in the IPOM + group. IPOM + had higher VAS after 1 day of surgery (MD -3.35; 95% CI -6.44; -0.27; P = 0.033; I2 = 99%) and between 7 and 10 days after surgery (MD -3.3; 95% CI -5.33, -1.28; P = 0.001; I2 = 99%). e-TEP repair showed with longer operative time (MD 52.89 min; 95% CI 29.74-76.05; P < 0.001; I2 = 92%). No differences were seen regarding LOS, seroma, recurrence, and readmission. The e-TEP repair is associated with lower short-term postoperative pain after VHR compared to IPOM +, but with longer operative time. More RCTs are required to assess these results with long-term follow-up and determine its role in the armamentarium of the abdominal wall surgeon.

Long-Term Outcomes of Component Separation for Abdominal Wall Hernia Repair.

Component separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown. To evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair. This cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024. Use of component separation technique during ventral hernia repair. The primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume. Among 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; P = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; P = .004). This study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.

Abdominoplasty With Umbilical Hernia Repair: A Long-term Comparative Analysis of Clinical Outcomes.

The risks and benefits of performing small fat-containing ventral or umbilical hernia repair (HR) during cosmetic abdominoplasty remains a reconstructive and aesthetic challenge for plastic surgeons. This study aimed to compare clinical outcomes in patients undergoing abdominoplasty with concurrent HR and abdominoplasty alone. Retrospective review of patients undergoing abdominoplasty with and without a concurrent HR from January 2015- June 2022 was performed. Patients were stratified by concurrent HR. All hernia patients underwent primary fascial repair, without the use of mesh. Demographics, surgical site occurrences (SSO) and cosmetic complications, including delayed healing and necrosis were assessed. Multivariate analysis was used to compare association of umbilical hernia repair with clinical outcomes. One hundred and six patients underwent abdominoplasty, 68 (64%) had concurrent HR. No significant difference in demographics was identified between groups including mean BMI (HR=27.2 kg/m2 and No HR= 26.3 kg/m2, P=0.73), and number of previous open hernia repairs (P=0.09). After a mean follow-up of 1.5 years, hernia recurrence rate was 1.4% (n=1), with a time to hernia recurrence of 12.2 months. After controlling for confounders, there was no difference in risk of SSO (OR 1.02 [0.31-3.36] P=0.978), cosmetic complications (OR 0.80 [0.14-4.57] P=0.805), procedure length (-21.5 minutes [-46.92-22.93] P=0.501), readmissions (2.8% vs. 0%, P=0.336), or reoperations (8.8% vs. 10%, P=0.766), compared to patients who underwent abdominoplasty alone. Abdominoplasty with concurrent HR can be performed safely and effectively, with no increase in adverse outcomes or cosmetic complications. The benefit of performing mesh-free HR with abdominoplasty can achieve an enhanced aesthetic outcome and reduce long-term abdominal wall morbidity.

Open versus robotic transversus abdominis release for ventral hernia repair: an updated systematic review, meta-analysis, and meta-regression.

Posterior component separation using transversus abdominis release (TAR) is well established as an option for repair of large hernia defects. TAR can be performed robotically (rTAR) or open (oTAR) with limited data to demonstrate benefit and guide decision making. We conducted a systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR). We searched Pubmed, Embase, Cochrane, and Web of Science for studies comparing rTAR and oTAR for VHR. Hybrid rTAR was not included in our analysis. Our primary outcomes were overall postoperative and intraoperative complications, surgical site occurrences (SSO), SSO requiring surgical intervention (SSOPI), surgical site infection (SSI) superficial or deep, and fascial closure. Additional outcomes were operative time (OT), readmission, length of hospital stay (LOS). We performed sensitivity analysis to explore reasons for heterogeneity and outliers, and a proportional meta-analysis of conversion during rTAR. We performed a meta-regression exploring the relationship of BMI, hernia defect and mesh width rTAR/oTAR with the analyzed outcome within each study. 503 studies were screened and seven studies were included in this analysis. Our sample totaled 780 patients, of which 298 (38.2%) underwent rTAR. Defect width ranged between 8.7 to 13.5cm (cm) for rTAR and 10 to 13.5cm for oTAR. Mean mesh area ranged from 66.9 to 980cm2 and from 51.3 to 1344cm2 for rTAR and oTAR respectively. We found lower overall complications (9% versus 24.6%; RR 0.43; 95% CI 0.26 to 0.73; P < 0.01) and intraoperative complication (5.9% versus 9.1%; RR 0.44; 95% CI 0.22 to 0.88; P = 0.02) rates for the rTAR group. There was no difference in fascial closure between the groups (99% versus 94.6%; RR 1.05; 95% CI 0.99 to 1.11; P = 0.11). rTAR presented lower SSI rates (2.5% versus 7.8%; RR 0.33; 95% CI 0.13 to 0.8; P = 0.01). No differences were found in SSO (16.3% versus 13.7%; RR 0.87; 95% CI 0.51 to 1.48; P = 0.6) or SSOPI (5.4% versus 8.9%%; RR 0.5; 95% CI 0.22 to 1.15; P = 0.1) rates. No statistically significant differences were found in superficial SSI (0.76% versus 3%; RR 0.36; 95% CI 0.07 to 1.75; P = 0.21) and deep SSI (0% versus 4.2%; RR 0.23; 95% CI 0.02 to 3.12; P = 0.27). Open surgery presented a lower OT (MD -67.7min; P < 0.001), but robotic surgery showed a reduced LOS (-3.9days; 95% CI -4.8 to -3.1; P < 0.001). No differences were found in readmission and 1year recurrence rates. The proportional meta-analysis showed a conversion to open rate of 6.4 per 100 patients (95% CI 3.3 to 12 patients) during rTAR. Meta-regression presented no statistically significant influences of rTAR/oTAR mesh width and defect width relations and BMI, despite the analysis was limited by the low number of studies. Robotic TAR may be associated with lower intraoperative and postoperative complications, lower SSI, shorter LOS, and longer operative times when compared to oTAR. Given the limitations of the included studies, randomized trials are needed to better evaluate the impact of the robotic-assisted surgery for complex abdominal wall reconstruction. CRD42024540991.

Long-term outcomes after open parastomal hernia repair at a high-volume center.

Open parastomal hernia repairs (OPHR) are complex with high recurrence rates and no clear optimal technique. This report summarizes long-term OPHR outcomes at a high-volume hernia center. OPHRs were identified from a prospectively maintained institutional database. Recurrence and wound complication rates were compared across operative techniques using standard statistical analysis. Of 97 OPHR patients, mean age was 61.9 ± 12.6years, 56.7% were female, 24.7% were diabetic, and average BMI was 31.3 ± 6.5kg/m2. Mean defect size was 125.3 ± 130.0cm2 and 41.2% were recurrent. Stomas included colostomies (56.7%), ileostomies (30.9%), and urostomies (12.4%). Patients underwent concurrent ventral hernia repair (56.7%), panniculectomy (22.7%), and component separation (30.9%). Patients either had their stoma reversed (13.4%), resited (25.8%), or repaired in situ (60.8%) with suture (11.9%) or mesh (88.1%) in a Sugarbaker (65.4%), keyhole (19.2%), or onlay (15.4%) configuration. Over a mean follow-up of 31.6 ± 35.9months, wound complications occurred in 18.6% and recurrences in 20.6%. There were no significant differences in recurrence by ostomy type. Recurrence rates were highest after in situ suture repair (42.9%), followed by resiting with mesh (34.8%), in situ with mesh (17.3%), and reversal (0.0%)(p = 0.042). When stomas were resited, prophylactic mesh compared to no mesh did not significantly impact recurrence (28.6%vs.50.0%;p = 0.570). Recurrence rates for in situ repairs were not statistically different by mesh technique (onlay 25.0%, Sugarbaker 17.7%, keyhole 10.0%;p = 0.751), but differed by location(retrorectus 50.0%, intraperitoneal 36.4%, onlay 25.0%, preperitoneal 6.5%;p = 0.035). Multivariable analysis did not demonstrate any independent predictors of recurrence or wound complications. This study represents the largest series to date describing long-term OPHR outcomes with a variety of techniques. Recurrence was greatest after in situ primary repair. There were no recurrences after stoma reversal. After ostomy resiting, all recurrences occurred at the new stoma site, independent of prophylactic mesh use. When the stoma was repaired in situ, preperitoneal mesh placement had the lowest recurrence. Optimal technique for OPHR remains unclear, but these results may inform preoperative discussions and surgical planning.

Comparisons of 30-day outcomes after ventral hernia repair by body mass index and surgical approach: a retrospective cohort study.

Obesity is a known risk factor for postoperative complication after ventral or incisional hernia repair (VIHR). Whether minimally invasive techniques can mitigate this risk for certain patients remains unknown. This study investigates whether MIS approaches offer advantages in reducing any medical or surgical complication after VIHR across clinically meaningful BMI categories. This study analyzes data from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR). The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan. This study includes adult patients receiving VIHR between Jan 2020 and September 2023. All elective VIHRs captured in the MSQC database were included in analysis. Univariate statistics were used for cohort summary and multivariate logistic regression was used to estimate the probability of any 30-day postoperative complication while controlling for age, sex, the interaction of BMI and surgical approach, medical comorbidities, hernia size, mesh use, use of component separation, and previous hernia repair. A total of 11,886 people met the study inclusion criteria. The median (IQR) age was 55.0 (44-65) and 5,111(43.0%) were female. The median (IQR) BMI was 31.7 (27.6-36.3). 5,260(44.3%) cases were performed with an MIS approach and 6,626(55.7%) were performed with an open approach. The adjusted relative risk of experiencing a complication after open repair when compared to MIS repair was 1.34 (95% CI [1.04-1.70], p = .02) in Obesity Class I, 1.62 (95% CI [1.23-2.14], p < .001) in Obesity Class II, and 2.31 (95% CI[1.49-3.56]) for Obesity Class III. MIS repair was associated with improved 30-day outcomes for patients with class I, II, and III obesity, but not for healthy to overweight patients. In clinical scenarios where delay for severely obese patients may be difficult, electing to use an MIS repair may be the optimal strategy to reduce risk of complications.

A Comparison of Open Ventral Hernia Repair Risk Stratification Systems: A Call for Consensus

Background/Objectives: Ventral hernia repair (VHR) is a common surgical intervention linked to specific surgical site complications. In such occurrences, the related morbidity is often substantial. Although known risk factors have long been recognized, their systematic inclusion in risk stratification systems lacks universal validation. This study evaluates the effectiveness and correspondence of three risk assessment tools—CeDAR, VHWG, and the modified VHWG—in predicting postoperative wound complications in VHR patients. Methods: We analyzed data from 203 patients who underwent VHR for incisional midline or lateral wall hernia across two surgical departments between 2019 and 2023. Each patient was scored using CeDAR, VHWG, and the modified VHWG systems. Outcomes were assessed based on surgical site occurrences (SSOs) such as seroma formation, wound infections, and recurrences. Results: The incidence of SSOs was 8.9%, with two recorded deaths (0.89%). CeDAR scores showed a statistically significant relationship with SSOs but failed to accurately predict complication rates across subgroups. The VHWG grading system effectively predicted higher complication rates for grades III and IV compared to grades I and II, though its modified version did not show significant predictive improvements. Secondary outcomes indicated a higher SSO rate in patients requiring posterior component separation (TAR) and those with larger hernia defects, though the differences were not statistically significant. Major preoperative risk factors, including smoking, diabetes, and obesity, did not show significant correlations with SSO rates in this study. Conclusions: Current risk estimation tools inadequately predict SSOs in VHR. Enhancing prediction accuracy will require incorporating both patient-specific and surgical factors, potentially through advanced algorithms and large-scale studies.

A study of comparison of perioperative complications in intraperitoneal onlay mesh technique vs extended view totally extraperitoneal ventral hernia repair

Background: Abdominal hernia occurs through the layers of the abdominal wall at a weak point. Laparoscopic ventral hernia repair (LVHR) is an established treatment for ventral hernias. This study was conducted in patients who underwent e-TEP and IPOM surgery for ventral hernia to characterize postoperative pain, recovery time, and quality of life. Predefined preoperative and peri-operative factors were examined for their potential impact. Methods: A prospective study on a total of 50 patients who underwent IPOM and e-TEP for ventral hernia was conducted, who fulfilled the inclusion criteria. Patients were randomized by simple random sampling technique and were divided into two groups of 25 each (Group A- e-TEP and Group B- IPOM). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Results: The eTEP approach provides benefits compared to IPOM in terms of reduced hospital stay, earlier return to work and cost effective. However, eTEP is linked to complex learning process and in the end the decision of the surgery type should be made on the basis of specific patient’s conditions, surgeon’s expertise and availability of resources Conclusions: In study we found that both surgeries were comparable, with each having some benefits over the other.

Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias

Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias

Development and Measurement Properties of the Danish Translation of the Groin Hernia-Q: Protocol for a Validation Study

Background: The patient reported outcome questionnaire Abdominal Hernia-Q is probably the most thoroughly validated patient-reported outcome measure specifically developed for patients undergoing ventral hernia repair. The present study aims to adapt and validate the Danish translation of the Abdominal Hernia-Q for patients undergoing groin hernia repair: the Groin Hernia-Q. Methods: This validation study will involve a total of 250 participants and it is divided into two substudies. Substudy 1 will focus on adapting the Abdominal Hernia-Q into the Groin Hernia-Q and assessing its content validity using the QQ-10 questionnaire. Substudy 2 will evaluate the structural validity, internal consistency, test-retest reliability, measurement error and construct validity of the Groin Hernia-Q, while also utilizing and comparing the results to the Carolinas Comfort Scale and Short-Form 12. Participants will be recruited both in a clinical setting and electronically. Data collection will be conducted through the platform Research Electronic Data Capture (REDCap). In addition to questionnaire data, this study will also involve perioperative and patient-related data extracted from the Danish National Patient Registry and the Danish Hernia Database. This study is part of the AFTERHERNIA Project. Conclusion: This study will provide a comprehensive validation of the Groin Hernia-Q, ensuring it becomes a valuable tool for assessing patient-reported outcomes in patients undergoing groin hernia repair. The questionnaire will contribute significantly to improved patient care through the AFTERHERNIA Project.

Innovative Single-Port Approach for Simultaneous Ventral Hernia Repair and Bariatric Surgery: A Retrospective Case Series Study (March 2020 - July 2023)

Background: This retrospective case series study explores the outcomes of single-port bariatric surgery (BS) with ventral hernia repair (VHR) in a simultaneous setting. Through a novel single-port laparoscopic approach, this research emphasizes on operative details, patient selection criteria, and the innovative nature of the technique when repairing ventral hernia in bariatric surgeries. Methods: The research was conducted from February 2021-February 2023 at Al-Noor Specialists Hospital, Makkah, Saudi Arabia. Six patients (5 females and 1 male) underwent simultaneous repair of ventral hernia alongside bariatric surgery through a single-port laparoscopic approach. Results: The study evaluates demographic data, pre-operative parameters, surgical approach, post-operative complications, and post-operative follow-up durations to provide comprehensive insights. Results show the average age of the respondents: 40.5 ± 9.44 years, with a mean BMI of 47 ± 8.25 kg/m2. At post-operative stage, the hospital stay was 48 hours for 50% patients with a mean follow-up duration; 13 ± 3.29 months. At post-surgery, the observed mean weight loss; 33.67 ± 6.66 kg, and the mean excess weight loss was 29.60 ± 5.30%. None of the post-operative complications were reported at the follow-up stage, except minimal seroma. Conclusion: The simultaneous single-port BS and VHR approach provides surgical benefits with lowered complication rates, surgical weight loss, and lesser recurrence of ventral hernia. Single-port bariatric laparoscopy is efficient in treating obese patients. However, further research must advocate for and establish long-term outcomes and broader application of this procedure.

Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery.

Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown. We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023. We performed propensity-score matching to address confounding and then chi-squared testing to examine access to robotic, laparoscopic, and open approaches. Secondary outcomes included 30-day readmissions, complications, and death and 1- and 2-year hernia recurrence and quality of life measured by HerQLes Summary and PROMIS Pain T-Scores analyzed with chi-squared, Fisher exact, and Wilcoxon testing. 2397 patients identified as Black, and 21,900 identified as white. Our propensity-score matched cohort included 2374 Black patients and 7122 white. Black and white groups had the same rates of laparoscopy (15% vs 15%). Patients who identified as Black were more likely to undergo robotic surgery (36% vs 32%). Open approach was 49% for Black and 53% for white (p = 0.005). For 30-day complications, we found Black patients were more likely to experience reoperation (2% vs 1%, p = 0.005) and less likely surgical site infection (1% vs 2%, p < 0.001). Hernia recurrence scores and perceived abdominal health based on HerQLes were not statistically significantly different. At 2years, absolute reported T-Scores were higher for Black patients (median 40 (IQR 31-49) vs 36 (31-46), p = 0.031). This is the first large-scale study examining access to robotic surgery, complications, and quality of life measures. We found patients who identified as Black were more likely than white counterparts to undergo robotic surgery, but they were more likely to require reoperation and had higher pain scores. Our data suggest equitable access still may not translate to equitable patient outcomes.

Long-term patient reported outcomes after robotic, laparoscopic, and open ventral hernia repair.

Current evidence demonstrates questionable incremental benefit of robotic abdominal wall (ventral) hernia repair when compared to other approaches. However, data are mainly limited to 30-day outcomes and do not capture long-term patient reported outcomes (PROs) where the robotic may provide distinct advantages. We analyzed patients who underwent ventral hernia repair from January 2020-September 30, 2022 in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC-COHR). Validated PROs included the Ventral Hernia Recurrence Inventory (VHRI), PROMIS Pain Intensity 3a (Pain 3a), and HerQLes quality of life measures. Survey weighting was employed to reduce non-response bias and balance respondents with the overall COHR population. Logistic regression was used to assess the relationship of operative approach with answering "Yes" to the 3 VHRI questions, reporting a worse than average Pain 3a score, and reporting a below median HerQLes score. Models accounted for patient, hernia, and operative characteristics. Our sample included 1583 patients undergoing hernia repair, of which 507 (32.0%) were robotic, 202 (12.8%) were laparoscopic, and 874 (55.2%) were open. Median follow up time was 1.3years (IQR 1.2-1.5). Patient characteristics were similar across approaches. Robotic repairs were more often performed electively, on larger hernias, and with mesh. After controlling for covariates, a robotic approach was associated with a lower predicted probability of reporting a bulge [19.5% (95% CI 15.7-23.2%)] than a laparoscopic approach [26.8% (95% CI 20.4-33.2%)], but was no different than an open approach [18.8% (95% CI 16.1-21.6%)]. No other differences in PROs were found by approach. We found a lower likelihood of reporting a bulge after robotic ventral hernia repair when compared with a laparoscopic approach, but no difference when compared with an open approach. No other differences in long-term PROs were found when comparing robotic to laparoscopic or open approaches.

Patient expectations and decisional regret in the management of ventral hernias.

Older adult patients have many factors to contemplate when considering elective ventral hernia repair. In this study, we aimed to understand whether our novel shared decision-making (SDM) aid helped reduce this population's decisional regret when choosing hernia management strategy. Patients ≥ 60years of age presenting for ventral hernia evaluation were randomized to two groups. The experimental group had their visit guided by our novel SDM aid. All patients took a survey prior to consultation outlining their treatment expectations. All patients were called within 6months to complete the Decision Regret Scale, which measures remorse after a healthcare decision. Seventy-two patients (36 control, 36 experimental) completed final follow-up. On initial expectations evaluation, 53 patients (74%) reported wanting surgical repair and 58 patients (81%) reported expecting surgical repair. Ultimately, 18 patients in the control group and 17 patients in the experimental group did not undergo surgery. The use of the SDM aid did not affect if patients chose observation (OR 0.44, p = 0.24) or result in a lower decision regret score (9.86 vs 9.31, p = 0.89). Surgery was associated with a lower decision regret score (3.38 vs 16.14; p = 0.001). Of those who did not undergo repair, patients initially wanting or expecting surgery had higher decision regret scores (22.83 vs 3.33, p < 0.001; 20.40 vs 5.50, p = 0.009). Nonoperative patients who chose observation had less regret than those needing medical optimization (9.50 vs 25.00, p = 0.04). There were no differences in decision regret scores based on initial wants or expectations for those who had surgical repair. Decisional regret following ventral hernia management is associated with patients' expectations prior to initial surgical consultation. The use of a decisional aid did not lower decision regret scores. These findings emphasize the need for upfront expectation setting and longitudinal programs to help patients reach their treatment goals.

Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study

Background: Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills. Objective: To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review. Methods: Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks. Results: In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P &lt; 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P &lt; 0.001) and VHR (16.8 vs 23.3; P &lt; 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P &lt; 0.001 and VHR: 29.6 vs 21.2 minutes; P &lt; 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills. Conclusions: The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.

Rise of the robots: implementing robotic surgery into the acute care surgery practice.

Acute Care Surgery (ACS) admissions and procedures are substantially increasing. ACS disproportionally accounts for a majority of morbidity and mortality among surgical patients. Minimally invasive techniques are associated with improved outcomes and shorter hospital length of stay within the ACS population. While laparoscopy is widespread, ACS surgeons have been slower to adopt the use of robotics. We aimed to evaluate the feasibility of incorporating robotic surgery within ACS practice. Robotic General Surgery operations performed by 8 Acute Care Surgeons from 5 local facilities within a large integrated healthcare system were queried over a 15 month period. Patients who underwent emergent, urgent, sub-acute, and elective robotic operations by ACS staff were identified. Demographics collected included age, gender, BMI, and ASA score. Outcomes recorded included procedure classification, total supply and implant charges (TSI), conversion to open, hospital length of stay (LOS), 30 day readmission, and 30 day mortality. Of 200 operations, the most common were Cholecystectomy (43.5%), Inguinal hernia repair (26.0%), Ventral hernia repair (18.0%), Appendectomy (5.0%), and Sigmoid Colectomy (3.5%). The median (± std dev) age was 48 ± 16.66years and BMI was 29.9 ± 8.79kg/m2. 46% of cases were sub-acute (n = 92), 33.5% were elective (n = 67), 14% were emergent (n = 28), and 6.5% were urgent (n = 13). Most patients were ASA 2 (107, 46.1%) or ASA 3 (71, 45.9%). The median (IQR) TSI and LOS were $1,770 (889.50) USD and 0.1 (0.9) days. Forty-one inpatient procedures were performed. Median LOS was 3days and expected LOS was 3.1days (O:E = 0.96). Five patients were readmitted within 30days, and there were no deaths within 30days. Robotic techniques may be safely implemented by ACS surgeons, potentially benefitting both patient and surgeon. LOS was similar between laparoscopic and robotic cases and only two cases required conversion to an open procedure. Next steps include a multi-center prospective trial comparing robotic to laparoscopic cases.