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Transabdominal (TA) versus totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair: a propensity score matching analysis

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Abstract

Purpose

Retromuscular mesh placement positioning utilizing the robotic platform can be performed using either a transabdominal or an extraperitoneal approach. The aim of this study is to compare short-term outcomes of robotic transabdominal access retromuscular (rTA-RM) repair and robotic totally extraperitoneal access retromuscular (rTEP-RM) repair for ventral hernias

Methods

Patients who underwent robotic retromuscular repair between February 2013–October 2019 were included in the study. A one-to-one propensity score matching (PSM) analysis was conducted to obtain two balanced groups. A comparative analysis was performed in terms of perioperative and early post-operative outcomes.

Results

A total of 214 patients were included for PSM analysis. 82 patients were allocated into each study group. Operative times were longer in rTA-RM group. Adhesiolysis was more frequently required in the rTA-RM group. Intra-operative complications occurred more frequently in patients who underwent rTA-RM repair (p = 0.120; 4.9% in rTA-RM vs. 0% in rTEP-RM). The rate of major complications during the first 90 days did not differ between groups (p = 0.277; 7.3% vs. 2.4%, respectively). The proportion of patients with minor perioperative complications was statistically higher in the rTA-RM group than the rTEP-RM group (p = 0.003; 30.5% vs. 11%, respectively). Overall rate of surgical site events was higher in the rTA-RM group than the rTEP-RM group (p = 0.049; 17.1% vs. 6.1%, respectively). Seroma frequency was higher after rTA-RM repair (p = 0.047; 13.4% vs. 3.7%).

Conclusion

Our data suggest that rTEP-RM repair was associated with shorter surgery duration and improved early post-operative outcomes in comparison with rTA-RM repair.

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Authors and Affiliations

  1. Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA

    Omar Yusef Kudsi, Karen Chang, Naseem Bou-Ayash & Fahri Gokcal

Authors
  1. Omar Yusef Kudsi
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  2. Karen Chang
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  3. Naseem Bou-Ayash
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  4. Fahri Gokcal
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Corresponding author

Correspondence to Fahri Gokcal.

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Conflict of interest

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

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The database used for this study 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., Chang, K., Bou-Ayash, N. et al. Transabdominal (TA) versus totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair: a propensity score matching analysis. Surg Endosc 34, 3550–3559 (2020). https://doi.org/10.1007/s00464-020-07574-9

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