Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database

• Published in: Surgical endoscopy Vol. 35; no. 9; pp. 5310 - 5314
• Main Authors: Angus, Andrew, DeMare, Alexander, Iacco, Anthony
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2021; Springer Nature B.V
• Subjects: 2020 SAGES Oral; Abdominal Surgery; Bladder; Body mass index; Collaboration; Endoscopy; Gastroenterology; Gynecology; Hepatology; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Laparoscopy; Male; Males; Medicine; Medicine & Public Health; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Prostate; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotics; Scars; Surgeons; Surgery; Surgical outcomes; Urological surgery; Prior surgery; AHSQC; Inguinal hernia; Robotic
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-08020-6

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.