A Retrospective Study Comparing the Operative Outcomes of Extraperitoneal, Retrorectus Access Laparoscopic and Robotic-Assisted Ventral Hernia Repairs.

Abstract

This retrospective study aims to evaluate the operative outcomes of laparoscopic and robotic extraperitoneal repair of abdominal wall defects via enhanced view total extraperitoneal (eTEP) retrorectus space access. A medical chart review was performed on consecutive eTEP cases from our unit, focused on collecting perioperative outcomes. One hundred and twenty cases were collected, 73 in the robotic group and 47 in the laparoscopic group. Approximately 38% of the robotic and 64% of the laparoscopic arms required component separation. In the overall population (irrespective of defect size and technique used), the robotic arm versus the laparoscopic arm had (a) significantly higher (P < 0.001) mean hernia defect, (b) shorter operating time (P < 0.001), (c) significantly fewer postoperative complications (P = 0.039), (d) significantly fewer pain scores at 24 hours and 14 days postsurgery (P = 0.002 and P < 0.001, respectively), and (e) better patient well-being scores (P = 0.001). The length of hospital stay and analgesic usage were comparable. A subgroup analysis by defect size (< 7 cm, 7-10 cm, and > 10 cm) revealed that approximately 51% of patients needed component separation in the laparoscopic group for defects < 7 cm, and 100% of patients needed it for hernias > 7 cm in this group. In the robotic group, no patient (0%) needed component separation for defects < 7 cm, and approximately 43% needed it for defects > 7 cm. This study reports encouraging short-term outcomes for the robotic-assisted eTEP approach in Indian settings. The robotic-assisted approach has the potential to reduce the requirement of component separation in patients with large ventral hernia defects. However, future prospective, randomized studies with long-term follow-up on recurrence will be needed to validate our findings.