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Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias

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Abstract

Background

The optimal repair of ventral hernia remains unknown. We aimed to evaluate the results after robotic-assisted laparoscopic transabdominal repair with retrorectus mesh placement (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for patients with small- or medium-sized ventral hernia.

Methods

This was a retrospective cohort study of consecutive patients undergoing elective rRetrorectus or IPOM repair for small or medium-sized primary ventral or incisional hernias. The primary outcome was the postoperative need for transverse abdominis plane (TAP) block or epidural analgesia, secondary outcomes were length of stay and postoperative complications. All patients were followed for 30 days postoperatively.

Results

A total of 59 patients were included undergoing rRetrorectus (n = 27) and IPOM (n = 32). Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median fascial defect area was slightly larger in the rRetrorectus group (9 cm2 vs. 6.2 cm2, P = 0.031). The duration of surgery was longer for rRetrorectus (median 117.2 min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesia was less after rRetrorectus compared with IPOM (3.7% versus 43.7%, P = 0.002). There were no severe complications or reoperations after either procedure. The length of stay was shorter after rRetrorectus (median 0 vs. 1 day, P < 0.001).

Conclusions

rRetrorectus was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM.

Registration Clinicaltrial.gov: NCT05320055.

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Funding

This study received no funding.

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Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark

    Mette W. Christoffersen, Lars N. Jørgensen & Kristian K. Jensen

  2. University of Copenhagen, Copenhagen, Denmark

    Kristian K. Jensen

Authors
  1. Mette W. Christoffersen
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  2. Lars N. Jørgensen
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  3. Kristian K. Jensen
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Correspondence to Mette W. Christoffersen.

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Disclosures

Dr. Lars Nannestad Jørgensen is invited speaker for Intuitive and BD and have educational activities for Medtronic. Dr. Kristian Kiim Jensen is a speaker for Intuitive and consultant for ConMed. Dr. Mette Willaume Christoffersen have no conflicts of interest or financial ties to disclose.

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Previous communication: Data are presented as an E-poster at the EHS-AHS Joint Congress, Denmark, October 2021.

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Christoffersen, M.W., Jørgensen, L.N. & Jensen, K.K. Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias. Surg Endosc 37, 1053–1059 (2023). https://doi.org/10.1007/s00464-022-09608-w

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