Robotic Transabdominal Preperitoneal (TAPP) Repair of Complex Inguinal Hernias
Omar Yusef Kudsi, MD, MBA, FACS Naseem Bou-Ayash, MD Fahri Gokcal, MD
Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA, USA
Background: Complex inguinal hernia repairs (IHR) have been defined based on previous relative contraindications for their minimally invasive repair. In this study, we aim to describe outcomes after complex robotic IHR (rIHR) and its associated challenges.
Methods: A retrospective analysis was performed of patients who underwent complex rIHR in an elective setting between 2013-2020. Patients with a recurrence after posterior IHR, history of prostatectomy, large scrotal hernia, or irreducible hernia after anesthesia induction (incarcerated) were included. Any patients with concomitant procedures or emergent repairs were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCIŽ) scoring systems.
Results: A total of 88 patients were identified. Accounting for bilateral IHRs, the total number of complex rIHRs was 110. No procedures were converted to an open approach, but one patient required a hybrid procedure. The average length of stay (LOS) and follow-up period were 0.2 days and 33 months, respectively. Four major complications (CD-grade III/IV) were observed. These included 3 seromas requiring drainage, one of which necessitated readmission, and 1 postoperative ICU-admission. No chronic pain or recurrence was observed. In a univariate analysis, no significant difference was found between patients with and without postoperative complications.
Conclusion: Complex rIHR may be performed with minimal LOS, complications, and adverse long-term sequelae. A patient-tailored approach and adequate surgical training and knowledge are essential to attempt these procedures.
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