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Erschienen in: Surgical Endoscopy 2/2018

20.07.2017

Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair

verfasst von: James G. Bittner IV, Sameer Alrefai, Michelle Vy, Micah Mabe, Paul A. R. Del Prado, Natasha L. Clingempeel

Erschienen in: Surgical Endoscopy | Ausgabe 2/2018

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Abstract

Background

Transversus abdominis release (TAR) is a safe, effective strategy to repair complex ventral incisional hernia (VIH); however, open TAR (o-TAR) often necessitates prolonged hospitalization. Robot-assisted TAR (r-TAR) may benefit short-term outcomes and shorten convalescence. This study compares 90-day outcomes of o-TAR and r-TAR for VIH repair.

Methods

A single-center, retrospective review of patients who underwent o-TAR or r-TAR for VIH from 2015 to 2016 was conducted. Patient and hernia characteristics, operative data, and 90-day outcomes were compared. The primary outcome was hospital length of stay, and secondary metrics were morbidity, surgical site events, and readmission.

Results

Overall, 102 patients were identified (76 o-TAR and 26 r-TAR). Patients were comparable regarding age, gender, body mass index, and the presence of co-morbidities. Diabetes was more common in the open group (22.3 vs. 0%, P = 0.01). Most VIH defects were midline (89.5 vs. 83%, P = 0.47) and recurrent (52.6 vs. 58.3%, P = 0.65). Hernia characteristics were similar regarding mean defect size (260 ± 209 vs. 235 ± 107 cm2, P = 0.55), mesh removal, and type/size mesh implanted. Average operative time was longer in the r-TAR cohort (287 ± 121 vs. 365 ± 78 min, P < 0.01) despite most receiving mesh fixation with fibrin sealant alone (18.4 vs. 91.7%, P < 0.01). r-TAR trended toward lower morbidity (39.2 vs. 19.2%, P = 0.09), less severe complications, and similar rates of surgical site events and readmission (6.6 vs. 7.7%, P = 1.00). In addition, r-TAR resulted in a significantly shorter median hospital length of stay compared to o-TAR (6 days, 95% CI 5.9–8.3 vs. 3 days, 95% CI 3.2–4.3).

Conclusions

In select patients, the robotic surgical platform facilitates a safe, minimally invasive approach to complex abdominal wall reconstruction, specifically TAR. Robot-assisted TAR for VIH offers the short-term benefits of low morbidity and decreased hospital length of stay compared to open TAR.
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Metadaten
Titel
Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair
verfasst von
James G. Bittner IV
Sameer Alrefai
Michelle Vy
Micah Mabe
Paul A. R. Del Prado
Natasha L. Clingempeel
Publikationsdatum
20.07.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 2/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5729-0

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