Concomitant midline ventral and inguinal hernia repair: can we create an algorithmic approach?

Area of Science:

• General Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Established guidelines exist for isolated ventral hernia repair (VHR) and inguinal hernia repair (IHR).
• Managing concomitant VHR and IHR lacks a standardized approach, especially with the advent of new surgical modalities like robotic surgery.
• A tailored, algorithmic strategy is needed to guide surgical decision-making for combined hernias.

Purpose of the Study:

• To develop and evaluate a decision-making algorithm for the surgical management of concomitant ventral and inguinal hernias (VHR and IHR).
• To compare outcomes across different surgical approaches, including open, laparoscopic, and robotic techniques, for combined hernia repair.

Main Methods:

• An algorithm categorizing patients into four treatment groups was developed.
• Retrospective comparison of demographics, comorbidities, operative characteristics, and surgical outcomes (30-day) for 92 patients undergoing combined VHR and IHR repair.
• Groups included variations of open, laparoscopic, and robotic VHR and IHR repairs.

Main Results:

• Patient demographics showed a median age of 64 years, predominantly male and white patients, with a median BMI of 27 kg/m².
• Ventral hernia size, operative time, and length of stay varied across the four treatment groups.
• No significant differences in 30-day postoperative outcomes, including emergency consults, readmissions, or complications, were observed among the groups.

Conclusions:

• The proposed algorithm, incorporating robotic surgery, provides a structured approach for managing concomitant VHR and IHR.
• This strategy facilitates the integration of advanced surgical techniques for general surgeons.
• The study demonstrates consistent favorable outcomes in a small patient cohort, supporting the algorithm's utility.