Laparoscopic vs Robotic Intraperitoneal Mesh Repair for Incisional Hernia: An Americas Hernia Society Quality Collaborative Analysis

• Published in: Journal of the American College of Surgeons Vol. 225; no. 2; pp. 285 - 293
• Main Authors: Prabhu, Ajita S., MD, FACS, Dickens, Eugene O., MD, FACS, Copper, Chad M., MD, FACS, Mann, John W., MD, FACS, Yunis, Jonathan P., MD, FACS, Phillips, Sharon, MSPH, Huang, Li-Ching, PhD, Poulose, Benjamin K., MD, MPH, FACS, Rosen, Michael J., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Aged; Female; Herniorrhaphy - methods; Humans; Incisional Hernia - surgery; Laparoscopy; Length of Stay - statistics & numerical data; Male; Middle Aged; Peritoneum; Postoperative Complications - epidemiology; Retrospective Studies; Robotic Surgical Procedures; Surgery; Surgical Mesh; Time Factors; laparoscopic; intraperitoneal mesh; incisional hernia; robotic; SSOPI; LOS; SSI; AHSQC; IQR; LapIPOM; SSO; rIPOM
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2017.04.011

Abstract Background Robotic intraperitoneal mesh placement (rIPOM) has recently emerged as an alternative to laparoscopic intraperitoneal mesh placement (LapIPOM) for minimally invasive incisional hernia repair. We aimed to compare LapIPOM to rIPOM in terms of hospital length of stay (LOS) and 30-day postoperative complications in patients undergoing incisional hernia repair within the Americas Hernia Society Quality Collaborative (AHSQC) Study Design Propensity score analysis was used to compare matched groups of patients within the AHSQC undergoing LapIPOM versus rIPOM. The primary outcome measure was hospital LOS, and secondary outcomes were 30-day wound events. Results 454 (71.9%) patients underwent LapIPOM and 177 (28.1%) underwent rIPOM. The laparoscopic group had an increased median LOS (1 vs 0 days; interquartile range (IQR) 3.00; p<0.001). The risk of surgical site occurrence (SSO) was higher in the LapIPOM group vs the rIPOM group (14% vs 5%; p=0.001), however SSO requiring procedural intervention (SSOPI) was similar between the groups (1% vs 0%; p=1). Operative time greater than 2 hours was more common in the rIPOM group (47% vs 31%; p<0.05). Conclusion Despite longer operative times using the rIPOM approach, patients undergoing rIPOM had a significantly shorter LOS than LapIPOM without additional risk of wound morbidity requiring intervention. Further studies are necessary to identify the best candidates for the rIPOM approach.