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