Robotic ventral hernia repair in morbidly obese patients: perioperative and mid-term outcomes

被引:12
作者
Gokcal, Fahri [1 ]
Morrison, Sara [1 ]
Kudsi, Omar Yusef [1 ]
机构
[1] Tufts Univ, Sch Med, Good Samaritan Med Ctr, One Pearl St, Brockton, MA 02301 USA
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2020年 / 34卷 / 08期
关键词
Robotic ventral hernia repair; Incisional hernia; Morbid obesity; CLASSIFICATION; RECURRENCE;
D O I
10.1007/s00464-019-07142-w
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Obesity is a growing epidemic and it has been found to be an independent risk factor for a multitude of perioperative complications. We describe our experience with morbidly obese patients who underwent robotic ventral hernia repair (RVHR), examining factors affecting perioperative and mid-term outcomes. Methods From a prospectively maintained database, all morbid obese (BMI >= 40 kg/m(2)) patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and the mid-term follow-up. Complications were assessed with validated grading systems and index. Univariate analyses and multivariate logistic regression analysis were performed to determine the factors associated with the development of any complication. Kaplan-Meier's time-to-event analysis was performed to calculate freedom-of-recurrence. Results Fifty patients with median BMI 42.9 kg/m(2) were included. The median last pain score before leaving PACU was 4. The mean LOS of all cohorts was 0.32 day. The postoperative complication rate was 46%. The most frequent complication was persistent pain/discomfort (32%) in early postoperative period. Minor complications (Clavien-Dindo grade-I and II) were seen in 40% of patients while major complications (Clavien-Dindo grade-III and IV) were seen in 6%. The maximum comprehensive complication index (R) score was 42.9. In regression analysis, BMI, adhesiolysis, intraperitoneal mesh placement, and off-console time were found to be significantly associated with postoperative complications. Mean follow-up was 22.7 months. Hernia recurrence was seen in 2% and the mean freedom-of-recurrence was 57.4 months (95% CI 54.6-60.2). Conclusions To our best knowledge, this study is the first to present outcomes of morbidly obese patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in morbid obesity with a low recurrence rate as well as a long freedom-of-recurrence time. Further studies are needed to better elucidate the role of robotic surgery in morbidly obese patients.
引用
收藏
页码:3540 / 3549
页数:10
相关论文
共 33 条
[1]   Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity [J].
Alfalah, H ;
Philippe, B ;
Ghazal, F ;
Jany, T ;
Arnalsteen, L ;
Romon, M ;
Pattou, F .
OBESITY SURGERY, 2006, 16 (02) :147-150
[2]   Technical Feasibility of Robot-Assisted Ventral Hernia Repair [J].
Allison, Nathan ;
Tieu, Ken ;
Snyder, Brad ;
Pigazzi, Alessio ;
Wilson, Erik .
WORLD JOURNAL OF SURGERY, 2012, 36 (02) :447-452
[3]   Development and Validation of a Risk-Stratification Score for Surgical Site Occurrence and Surgical Site Infection after Open Ventral Hernia Repair [J].
Berger, Rachel L. ;
Li, Linda T. ;
Hicks, Stephanie C. ;
Davila, Jessica A. ;
Kao, Lillian S. ;
Liang, Mike K. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2013, 217 (06) :974-982
[4]   Obesity and laparoscopic repair of ventral hernias [J].
Birgisson, G ;
Park, AE ;
Mastrangelo, MJ ;
Witzke, DB ;
Chu, UB .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2001, 15 (12) :1419-1422
[5]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[6]  
Evans KK, 2012, AM SURGEON, V78, P388
[7]  
Flancbaum L, 1998, ANNU REV MED, V49, P215
[8]   Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up [J].
Froylich, Dvir ;
Segal, Miriam ;
Weinstein, Adam ;
Hatib, Kamal ;
Shiloni, Eitan ;
Hazzan, David .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2016, 30 (02) :670-675
[9]   Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes [J].
Gonzalez, Anthony ;
Escobar, Ernesto ;
Romero, Rey ;
Walker, Gail ;
Mejias, Jacqueline ;
Gallas, Michelle ;
Dickens, Eugene ;
Johnson, Christopher J. ;
Rabaza, Jorge ;
Kudsi, Omar Yusef .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2017, 31 (03) :1342-1349
[10]  
Gonzalez Rodrigo, 2003, JSLS, V7, P323