Robotic management of complex traumatic hernias: A single-center experience

Blunt traumatic lateral abdominal-wall hernias are complex injuries often resulting from high-energy mechanisms. These injuries commonly involve disruption of the transversus abdominis muscle, obliques, as well as potential injury avulsion of the diaphragm in thoracoabdominal hernias. Because of the variety of injury patterns, blunt traumatic lateral abdominal-wall hernias present unique reconstructive challenges, particularly when involving the iliac crest or costal margin. Despite increasing use of robotic-assisted techniques for abdominal wall reconstruction, limited data exist on their use in traumatic hernias.

We conducted a retrospective review of patients undergoing ventral hernia repair at our high-volume hernia center. Patients with lateral hernias secondary to blunt trauma were identified. Demographics, hernia characteristics, operative techniques, and outcomes were analyzed. Subgroup analysis was performed for patients undergoing robotic transversus abdominis release.

Of 109 lateral hernia repairs, 21 (19.3%) were trauma-related. Most were due to motor vehicle collisions (76.2%) and commonly involved flank (L2) and lumbar (L4) regions. Robotic repair was performed in all cases, including robotic transversus abdominis release in 38.1% and conversion to open transversus abdominis release in 9.5%. Mean hernia width was 10.7 cm, with a mean mesh area of 455.5 cm². Complications included 3 asymptomatic seromas (14.3%) and 1 deep muscle abscess requiring readmission. No hernia recurrences were observed during a median follow-up of 1 year.

Robotic repair of blunt traumatic lateral abdominal-wall hernias is feasible and safe, with low complication and recurrence rates. These injuries frequently coexist with midline defects and may require advanced techniques, underscoring the importance of surgical expertise and optimization.