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Comparison of perioperative and mid-term outcomes between laparoscopic and robotic inguinal hernia repair

  • 2022 SAGES Oral
  • Published:
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Abstract

Background

Although the advantages of laparoscopic inguinal hernia repair (LIHR) have been described, guidelines regarding robotic inguinal hernia repair (RIHR) have yet to be established, despite its increased adoption as a minimally invasive alternative. This study compares the largest single-center cohorts of LIHR and RIHR and aims to shed light on the differences in outcomes between these two techniques.

Methods

Patients who underwent LIHR or RIHR over an 8-year period were included as part of a retrospective analysis. Variables were stratified by preoperative, intraoperative, and postoperative timeframes. Complications were listed according to the Clavien–Dindo classification system and comprehensive complication index (CCI®). Study groups were compared using univariate analyses and Kaplan–Meier’s time-to-event analysis.

Results

A total of 1153 patients were included: 606 patients underwent LIHR, while 547 underwent RIHR. Although demographics and comorbidities were mostly similar between the groups, the RIHR group included a higher proportion of complex hernias. Operative times were in favor of LIHR (42 vs. 53 min, p < 0.001), while RIHR had a smaller number of peritoneal breaches (0.4 vs. 3.8%, p < 0.001) as well as conversions (0.2 vs. 2.8%, p < 0.001). The number of patients lost-to-follow-up and the average follow-up times were similar (p = 0.821 and p = 0.304, respectively). Postoperatively, CCI® scores did not differ between the two groups (median = 0, p = 0.380), but Grade IIIB complications (1.2 vs. 3.3%, p = 0.025) and recurrences (0.8% vs. 2.9%, p = 0.013) were in favor of RIHR. Furthermore, estimated recurrence-free time was higher in the RIHR group [p = 0.032; 99.7 months (95% CI 98.8–100.5) vs. 97.6 months (95% CI 95.9–99.3).

Conclusion

This study demonstrated that RIHR may confer advantages over LIHR in terms of addressing more complex repairs while simultaneously reducing conversion and recurrence rates, at the expense of prolonged operation times. Further large-scale prospective studies and trials are needed to validate these findings and better understand whether RIHR offers substantial clinical benefit compared with LIHR.

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Authors and Affiliations

  1. Department of Surgery, Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA

    Omar Yusef Kudsi, Georges Kaoukabani & Fahri Gokcal

  2. Department of Surgery, Tufts Medical Center, Boston, MA, USA

    Omar Yusef Kudsi & Naseem Bou-Ayash

Authors
  1. Omar Yusef Kudsi
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  2. Naseem Bou-Ayash
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  3. Georges Kaoukabani
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  4. Fahri Gokcal
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Correspondence to Omar Yusef Kudsi.

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Disclosures

Dr. Kudsi has received teaching course, grant funding, and/or consultancy fees from Intuitive Surgical and W.L. Gore outside the submitted work. Drs. Bou-Ayash, Kaoukabani, and Gokcal have no conflicts of interest or financial ties to disclose.

Ethical approval

The database used for this study was approved by the Institutional Review Board.

Research involving human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kudsi, O.Y., Bou-Ayash, N., Kaoukabani, G. et al. Comparison of perioperative and mid-term outcomes between laparoscopic and robotic inguinal hernia repair. Surg Endosc 37, 1508–1514 (2023). https://doi.org/10.1007/s00464-022-09433-1

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  • DOI: https://doi.org/10.1007/s00464-022-09433-1

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