Robotic transabdominal preperitoneal repair of complex inguinal hernias

Abstract

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 the associated challenges. MATERIALS AND METHODS: A retrospective analysis was performed of patients who underwent complex rIHR in an elective setting between 2013 and 2020. Patients included into the study were those with a recurrence after posterior IHR, history of prostatectomy, large scrotal hernia, or irreducible hernia after anesthesia induction (incarcerated). Any patients with concomitant procedures or emergent repairs were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCI®) scoring systems. RESULTS: A total of 88 patients were identified. Accounting for bilateral IHRs, the total number of complex rIHRs was 110. Although there were no conversions to an open approach, one patient required a hybrid procedure. The average length of stay (LOS) and follow-up period were 0.2 days and 33 months, respectively. A total of four major complications (CD-Grade III/IV) were observed. These included three seromas requiring drainage, one of which necessitated readmission, and 1 postoperative intensive care unit admission. No chronic pain or recurrence was observed. The CCI® scores were ranged between 0 and 42.4. In a univariate analysis, no statistically significant variable 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.