Abstract
Very few studies have documented perioperative outcomes of ventral hernia repair in octogenarians. The aim of this study is to report the perioperative and the long-term outcomes of robotic ventral hernia repair (RVHR) in aged 80–89 years patients. From a prospectively maintained database, aged 80–89 years patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and long-term follow-up. Complications were assessed with validated grading systems and index. 21 octogenarians with average age 83.48 were included. Intraperitoneal onlay mesh repair, transabdominal preperitoneal repair, retromuscular repair with or without transversus abdominis release technique were performed without conversion. The average operating time was 150 min. The mean hospital length of stay of all cohorts was 1.24 day. There was a strong correlation between operating time and hospital length of stay. The median follow-up was 23.5 months. According to Clavien–Dindo classification, grade-I and grade-II complications were observed in 23.8% and 28.6% patients, respectively; major complications (grade-III and IV) were not observed. The maximum Comprehensive Complication Index® score was 29.6. None of the patients experienced hernia recurrence or chronic pain. To our best knowledge this study is the first to present perioperative as well as long-term outcomes of octogenarian patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in octogenarians.
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References
Bloom DE, Mitgang E, Osher B (2016) Demography of Global Aging, IZA Discussion Papers, No. 10164, Institute for the Study of Labor (IZA), Bonn
Caglia P, Tracia A, Borzi L, Amodeo L, Tracia L, Veroux M, Amodeo C (2014) Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg 12(Suppl 2):S164–S169. https://doi.org/10.1016/j.ijsu.2014.08.357
Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138(10):1083–1088. https://doi.org/10.1001/archsurg.138.10.1083
Watters JM (2002) Surgery in the elderly. Can J Surg 45(2):104–108
Neupane R, Fayezizadeh M, Majumder A, Novitsky YW (2017) Is old age a contraindication to elective ventral hernia repair? Surg Endosc 31(11):4425–4430. https://doi.org/10.1007/s00464-017-5492-2
Saber AA, Elgamal MH, Mancl TB, Norman E, Boros MJ (2008) Advanced age: is it an indication or contraindication for laparoscopic ventral hernia repair? JSLS 12(1):46–50
Lee YK, Iqbal A, Vitamvas M, McBride C, Thompson J, Oleynikov D (2008) Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients? Hernia 12(3):239–242. https://doi.org/10.1007/s10029-007-0312-6
Blount AL, Craft RO, Harold KL (2009) Safety of laparoscopic ventral hernia repair in octogenarians. JSLS 13(3):323–326
Spaniolas K, Trus TL, Adrales GL (2014) Ventral hernia repairs in the oldest-old: high-risk regardless of approach. Surg Endosc 28(4):1230–1237. https://doi.org/10.1007/s00464-013-3313-9
Nishikawa M, Watanabe H, Kurahashi T (2017) Safety and feasibility of robot-assisted radical prostatectomy for clinically localized prostate cancer in elderly Japanese patients. Prostate Int 5(1):13–16. https://doi.org/10.1016/j.prnil.2017.01.001
Buchs NC, Addeo P, Bianco FM, Ayloo S, Elli EF, Giulianotti PC (2010) Safety of robotic general surgery in elderly patients. J Robot Surg 4(2):91–98. https://doi.org/10.1007/s11701-010-0191-1
Ceccarelli G, Andolfi E, Biancafarina A, Rocca A, Amato M, Milone M, Scricciolo M, Frezza B, Miranda E, De Prizio M, Fontani A (2017) Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review. Aging Clin Exp Res 29(Suppl 1):55–63. https://doi.org/10.1007/s40520-016-0676-5
Okumura N, Son T, Kim YM, Kim HI, An JY, Noh SH, Hyung WJ (2016) Robotic gastrectomy for elderly gastric cancer patients: comparisons with robotic gastrectomy in younger patients and laparoscopic gastrectomy in the elderly. Gastric Cancer 19(4):1125–1134. https://doi.org/10.1007/s10120-015-0560-6
Coakley KM, Sims SM, Prasad T, Lincourt AE, Augenstein VA, Sing RF, Heniford BT, Colavita PD (2017) A nationwide evaluation of robotic ventral hernia surgery. Am J Surg 214(6):1158–1163. https://doi.org/10.1016/j.amjsurg.2017.08.022
Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x
Petro CC, Novitsky YW (2016) Classification of hernias. Hernia surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27470-6_2
Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267. https://doi.org/10.1007/s10029-012-0911-8
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732
Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, Sharp KW, Poulose BK (2016) Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg 212(1):81–88. https://doi.org/10.1016/j.amjsurg.2015.06.007
Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877. https://doi.org/10.1016/j.jamcollsurg.2006.08.026
Lindmark M, Strigard K, Lowenmark T, Dahlstrand U, Gunnarsson U (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42(11):3528–3536. https://doi.org/10.1007/s00268-018-4642-6
Evers BM, Townsend CM Jr, Thompson JC (1994) Organ physiology of aging. Surg Clin N Am 74(1):23–39
Hashimoto S, Hashikura Y, Munakata Y, Kawasaki S, Makuuchi M, Hayashi K, Yanagisawa K, Numata M (1993) Changes in the cardiovascular and respiratory systems during laparoscopic cholecystectomy. J Laparoendosc Surg 3(6):535–539. https://doi.org/10.1089/lps.1993.3.535
Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK (2018) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg 267(2):210–217. https://doi.org/10.1097/SLA.0000000000002244
Celio AC, Kasten KR, Pofahl WE 2nd, Pories WJ, Spaniolas K (2016) Causes of readmission after laparoscopic and open ventral hernia repair: identifying failed discharges and opportunities for action. Surgery 160(2):413–417. https://doi.org/10.1016/j.surg.2016.03.021
Tevis SE, Weber SM, Kent KC, Kennedy GD (2015) Nomogram to predict postoperative readmission in patients who undergo general surgery. JAMA Surg 150(6):505–510. https://doi.org/10.1001/jamasurg.2014.4043
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Drs. Gokcal and Morrison have no conflicts of interest or financial ties to disclose. Dr. Kudsi receives teaching course and/or consultancy fees from Intuitive, Bard, Medtronic, Gore, Optecks, Medrobotic, outside the submitted work.
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Gokcal, F., Morrison, S. & Kudsi, O.Y. Robotic ventral hernia repair in octogenarians: perioperative and long-term outcomes. J Robotic Surg 14, 275–281 (2020). https://doi.org/10.1007/s11701-019-00979-2
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DOI: https://doi.org/10.1007/s11701-019-00979-2