Clinical Outcomes and Costs of Retromuscular and Intraperitoneal Onlay Mesh Techniques in Robotic Incisional Hernia Repair


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Kudsi O. Y.

SAGES, Montreal, Kanada, 29 Mart - 01 Nisan 2023, cilt.37, ss.217-218, (Tam Metin Bildiri)

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Cilt numarası: 37
  • Doi Numarası: 10.1007/s00464-023-10071-4
  • Basıldığı Şehir: Montreal
  • Basıldığı Ülke: Kanada
  • Sayfa Sayıları: ss.217-218
  • Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet

Özet

Objective: To compare clinical outcomes and financial cost of

intraperitoneal onlay mesh(IPOM) versus retromuscular (RM) repairs

in robotic incisional hernia repairs (rIHR).

Methods: Patients who underwent either IPOM or RM elective rIHR

from 2012 to 2022 were included. Patients’ demographics, operative

details, postoperative outcomes and hospital costs were directly

compared.

Results: 69 IPOM and 55 RM were included. Mean ± Standard-

Deviation of age and body mass index did not differ between both

groups(IPOM vs RM: 59.3 ± 11.2 vs. 57.5 ± 14, p = 0.423;

34.1 ± 6.3 vs. 33.2 ± 6.9, p = 0.435, respectively). Comorbidities

and hernia characteristics were comparable. Comparison of intraoperative

variables is presented in the table below. Extensive lysis of

adhesions was required more often in IPOM(18 vs. 6 in RM, p =

0.034). Defect closure was achieved in 100% of RM vs. 81.2% in

IPOM (p\0.001). Median(interquartile range) postoperative pain

score was higher in RM than in IPOM[5(3–7) vs. 4(3–5), respectively,

p = 0.006]. Median length of stay (0 days) and same-day

discharge rate did not differ between groups (p = 0.598, p = 0.669,

respectively). Six(8.7%) patients in the IPOM group versus one

(1.8%) patient in the RM group were readmitted to hospital within

30-day postoperatively (p = 0.099). Perioperative complications were

higher in IPOM (p = 0.011; 34.8% vs. 14.5% in RM) with higher

Comprehensive Complication Index  morbidity scores [0(0–12.2) vs

0(0–0) in RM, p = 0.008)], Clavien-Dindo grade-II complications (8

vs 0 in RM, p = 0.009), and surgical site events (17 vs. 5 in

RM, p = 0.024). Recurrence rate was higher in IPOM(7.2%) vs.

RM(1.8%) but did not statistically differ between both groups

(p = 0.226) with a follow-up of 57 (± 28) months. Hospital costs did

not differ between groups [IPOM: $9,978 (7,031–12,926) vs. RM:

$8,961 (6,701–11,222), p = 0.300]. Although postoperative complication

costs were higher in IPOM ($2,436 vs RM: $161, p = 0.020),

total costs were comparable [IPOM: $12,415(8,700–16,130) vs. RM:

$9,123(6,789–11,457), p = 0.080].

Conclusion: Despite retromuscular repairs having lower postoperative

complications than intraperitoneal onlay mesh repairs, both

techniques offered encouraging long-term results in robotic incisional

hernia repair at a comparable total cost.

Comparison of Intraoperative Variables.