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Comparing rates of bowel injury for laparoscopic and robotic ventral hernia repair: a retrospective analysis of the abdominal core health quality collaborative

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Abstract

Purpose

Bowel injury during laparoscopic and robotic ventral hernia repair is a rare but potentially serious complication. We sought to compare bowel injury rates during minimally invasive approaches to ventral hernia repair using a national hernia registry.

Methods

Patients undergoing elective laparoscopic and robotic ventral hernia repair (including cases converted-to-open) between 2013 and 2021 were retrospectively identified in the Abdominal Core Health Quality Collaborative registry. The primary outcome was bowel injury, which included partial- and full-thickness injuries and re-operations for missed enterotomies. Statistical analysis was performed using multivariate logistic regression.

Results

Overall, 10,660 patients were included (4116 laparoscopic, 6544 robotic). The laparoscopic group included more incisional hernias (68% vs 62%, p < 0.001) and similar rates of recurrent hernias (23% vs 22%, p = 0.26). A total of 109 bowel injuries were identified, with more occurring in the laparoscopic group (55 [1.3%] laparoscopic vs. 54 [0.8%] robotic; p = 0.01). Specifically, there were more full-thickness and missed enterotomies in the laparoscopic group (29 laparoscopic vs. 20 robotic; p = 0.012). Bowel injury resulted in higher rates of wound morbidity and major post-operative complications including sepsis, re-admission, and re-operation. Following adjustment for recurrent and incisional hernias, prior mesh, patient age, and hernia width, bowel injury during laparoscopic repair remained significantly more likely than bowel injury during robotic repair (OR 1.669 [95% C.I.: 1.141–2.440]; p = 0.008).

Conclusion

In a large registry, laparoscopic ventral hernia repair is associated with an increased risk of bowel injury compared to repairs utilizing the robotic platform. Knowing the limitations of retrospective research, large national registries are well suited to explore rare outcomes which cannot be feasibly assessed with randomized controlled trials.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    J. D. Thomas

  2. Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    C. K. Gentle, D. M. Krpata, A. S. Prabhu, A. Fafaj, S. J. Zolin, S. Rosenblatt, M. J. Rosen & C. C. Petro

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    S. E. Phillips

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  1. J. D. Thomas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JDT and SEP. The first draft of the manuscript was written by JDT and all authors commented on previous versions of the manuscript. Final manuscript was edited and prepared by CKG. All authors read and approved the final manuscript.

Corresponding author

Correspondence to C. C. Petro.

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Conflict of interest

Ajita S. Prabhu: intuitive research support and speaking honoraria, CMR surgical consulting fees, verb surgical consulting fees. Michael J. Rosen: receives salary support for his role as the medical director of the Americas Hernia Society Quality Collaborative; board member of Ariste Medical Inc. and has stocks from Ariste Medical; ongoing research grants from Pacira Pharmaceuticals and Intuitive Inc. David M. Krpata: received an educational grant from W.L. Gore. Aldo Fafaj: resident research grant from the Americas Hernia Society Quality Collaborative. None of these conflicts of interest are related to the submitted work. All other authors report no conflicts of interest.

Ethics approval

This study received Institutional Review Board approval at our institution.

Human and animal rights and Informed consent

Additionally, no animals were involved in any way in the conduct of the research.

Informed consent

Since this is a retrospective study with minimal risk, the requirement for informed consent was waived as is standard for this kind of research.

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Thomas, J.D., Gentle, C.K., Krpata, D.M. et al. Comparing rates of bowel injury for laparoscopic and robotic ventral hernia repair: a retrospective analysis of the abdominal core health quality collaborative. Hernia 26, 1251–1258 (2022). https://doi.org/10.1007/s10029-022-02564-3

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