Robotic intraperitoneal onlay versus totally extraperitoneal (TEP) retromuscular mesh ventral hernia repair: A propensity score matching analysis of short-term outcomes - 27/09/20

Doi : 10.1016/j.amjsurg.2020.01.003

Omar Yusef Kudsi ^a,^b,^⁎ , Fahri Gokcal ^a , Karen Chang ^a
^a Good Samaritan Medical Center, 235 N Pearl St, Brockton, MA, 02301, USA
^b Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA

^∗Corresponding author. One Pearl Street, Brockton, MA, 02301, USA.One Pearl StreetBrocktonMA02301USA

Abstract

Background

Short-term outcomes of robotic intraperitoneal onlay mesh(rIPOM) versus robotic totally extraperitoneal retromuscular mesh(rTEP-RM) ventral hernia repair were compared.

Methods

A retrospective review of prospectively collected data of patients was conducted. A one-to-one propensity score matching(PSM) analysis was performed to achieve two well-balanced groups in terms of preoperative variables. A univariate and multivariate analysis were conducted to determine factors influencing post-operative outcomes.

Results

Of 291 rIPOM and rTEP-RM procedures, 68 patients were assigned to each group after PSM. Operative times were longer for the rTEP-RM group. Adhesiolysis was more frequently required in rIPOM. The rTEP-RM allowed for a greater mesh-to-defect ratio. The rate of overall perioperative complications, Clavien-Dindo grades, and surgical site events were higher for the rIPOM group than the rTEP-RM group. The Comprehensive Complication Index® morbidity scores were lower in favor of rTEP-RM group. Adhesiolysis, rIPOM, and craniocaudal defect size were predictors for post-operative complications.

Conclusion

Robotic TEP-RM repair has better early postoperative outcomes for ventral hernias, suggesting that it may be preferable over robotic IPOM repair. Further studies with longer follow-up are needed.

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Graphical abstract

Image 1

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Highlights

•	Robotic TEP-RM ventral hernia repair has lower morbidity.
•	Adhesiolysis could be avoided in robotic TEP-RM repair.
•	Robotic TEP-RM repair allows a greater mesh-to-defect ratio.
•	Robotic TEP-RM repair has longer operative times.

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Keywords : Totally extraperitoneal, TEP, Robotic ventral hernia repair, Intraperitoneal onlay mesh, IPOM