Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-match
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and Other Interventional Techniques
2020 SAGES ORAL
Evaluating outcomes for robotic‑assisted inguinal hernia repair in males with prior urologic surgery: a propensity‑matched analysis from a national database Andrew Angus1 · Alexander DeMare1 · Anthony Iacco1,2,3 Received: 4 April 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Controversy exists regarding the safety and effectiveness of minimally invasive inguinal hernia repairs in patients with a history of prior urologic pelvic operations (PUPO), such as a prostatectomy, which causes scarring and disruption of the retropubic tissue planes. Our study sought to examine whether a history of PUPO impacts surgical outcomes in males undergoing robotic-assisted inguinal hernia repair. Methods The Americas Hernia Society Quality Collaborative (AHSQC) database was queried to identify male patients who underwent a robotic inguinal hernia repair with 30-day follow-up. A sub-query was performed to identify subjects within the cohort with a documented history of PUPO. Propensity score matching was subsequently utilized to evaluate for differences in intra-operative complications and short-term post-operative outcomes. Results In total, 1664 male patients underwent robotic-assisted inguinal hernia repair, of whom 65 (3.9%) had a PUPO. After a 3:1 propensity score matching with hernia repair patients who did not have prior procedures, 195 (11.7%) males were included in the comparison cohort. There were no documented vascular, bladder, or spermatic cord injuries in either group. There was no difference in 30-day readmission rate (5% vs. 3%, respectively, p = 0.41). No hernia recurrences were recorded within the 30-day follow-up period in either group. There was no statistical difference in post-operative complications (including seroma formation, hematoma, and surgical site occurrences) between the two groups (14% vs. 8%, p = 0.18). Conclusions In an experienced surgeon’s hands, robotic-assisted minimally invasive inguinal hernia repair may be an alternative to open repair in patients with PUPO who were previously thought to be poor minimally invasive surgical candidates. Keywords Inguinal hernia · Robotic · Prior surgery · AHSQC The lifetime occurrence for the development of a groin hernia can be as high as 27–43% in males and 3–6% in females, making inguinal hernia repair one of the most commonly performed surgical operations worldwide [1]. Although open inguinal hernia repair remains the most common approach, minimally invasive surgery (MIS) techniques such as the totally extra-peritoneal (TEP) and trans-abdominal * Anthony Iacco [email protected] 1
Department of Surgery, Beaumont Health, Royal Oak, MI, USA
2
Oakland University William Beaumont School of Medicine, Rochester, MI, USA
3
Department of Surgery, Beaumont Health, 3535 W 13 Mile Rd. Suite 204, Royal Oak, MI 48073, USA
pre-peritoneal (TAPP) approach are becoming increasingly popular [2]. Consensus groups have
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