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Use of a Rat Model to Study Ventral Abdominal Hernia Repair
Published on: October 2, 2017
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Robotic Ventral Hernia Repair: Lessons Learned From a 7-year Experience
Omar Yusef Kudsi1, Fahri Gokcal1, Naseem Bou-Ayash1
1Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts.
Annals of Surgery
|August 12, 2021
Summary
Robotic ventral hernia repair (RVHR) outcomes vary by technique. Transabdominal preperitoneal (rTAPP) has high short-term success but high recurrence, while transversus abdominis release (rTAR) has lower short-term success but excellent long-term durability.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Hernia Repair
Background:
- Robotic ventral hernia repair (RVHR) is a novel approach requiring more data on long-term outcomes.
- Identifying predictors of adverse events is crucial for optimizing RVHR patient selection and management.
Purpose of the Study:
- To compare outcomes of different prosthetic reinforcement techniques in RVHR.
- To evaluate short-term (90-day) and long-term (5-year) outcomes, including recurrence rates.
- To identify patient-specific and procedure-specific predictors of complications and recurrence.
Main Methods:
- Retrospective analysis of 644 RVHR procedures over 7 years.
- Comparison of four techniques: robotic intraperitoneal onlay mesh (rIPOM), transabdominal preperitoneal (rTAPP), Rives-Stoppa (rRS), and transversus abdominis release (rTAR).
- Assessment of 90-day failure to close (FFC) and 5-year failure to re-operate (FFR) using Kaplan-Meier curves.
Main Results:
- rTAPP showed the highest 90-day FFC (89.5%) but the lowest 5-year FFR (93.3%).
- rTAR had the lowest 90-day FFC (71%) but the highest 5-year FFR (100%).
- Incisional hernia was the sole predictor of 5-year recurrence; coronary artery disease, lysis of adhesions, and operative time predicted 90-day complications.
Conclusions:
- rTAPP is not recommended due to high recurrence rates.
- rIPOM and rRS demonstrate favorable short- and long-term outcomes.
- rTAR is associated with higher perioperative morbidity but shows promising recurrence rates, warranting longer follow-up.
