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P009: ROBOTIC ETEP REPAIR FOR VENTRAL HERNIA DEMONSTRATES IMPROVED OUTCOMES IN HIGH BMI PATIENTS.
Salaam Sadi, MD; Jessica Zaman, MD, FACS; Lisa Teixeira, MS; Ashar Ata, MBBS, PHD; Pooja Patel, MD; T.Paul Singh, MD, FACS; Albany Medical Center
Background: Obesity is a risk factor for perioperative morbidity and recurrence after ventral hernia repair (VHR). Robotic-assisted enhanced-view totally extraperitoneal (eTEP) is a novel approach to VHR in which the risks associated with obesity are not well-studied. We seek to compare short-term outcomes of patients undergoing robotic eTEP with BMI above and below 35 kg/m2.
Methods: A retrospective chart review of a single surgeon’s first 50 patients (April 2018 to August 2019) who underwent eTEP was performed. The patients were divided into two groups depending on their BMI: low BMI group (BMI <35 kg/m2) and high BMI group (BMI ≥35 kg/m2).
Patient demographics and co-morbidities, hernia characteristics, perioperative variables, and 30-day post-operative outcomes were compared between these groups.
Statistical analysis was performed using STATA 15.0. Differences in demographics, clinical characteristics, and outcomes were analyzed using Chi-square tests, Fisher exact test, independent t-test or Mann-Whitney test, as appropriate. A p value of 0.05 was defined as statistically significant.
Results: Of the 50 patients who underwent robotic eTEP VHR, 18 patients had BMI ≥35 kg/m2(36%). There were no significant differences between the low and high BMI groups in terms of age, gender, and perioperative risk factors including ASA score, DM, smoking status, steroid use and prior hernia repair.
The mean hernia size was significantly larger in the high BMI group (175.07 vs. 70.79 cm2, p=0.012). However, there were no significant differences between the two cohorts in terms of mesh size (480.67 vs. 405.88 cm2, p=0.30), operative time (185.94 vs. 142.78 min, p=0.10), and procedure conversion to TAPP (5.56% vs 3.13%) or an open approach (5.56% vs. 0.00%, p=0.44).
The mean hospital stay was comparable (44.03 vs. 33.14 hours, p=0.90). There were no incidences of wound infection, hematoma, bowel obstruction or ileus within the 30-day post-operative period in either group. The few post-operative complications were largely minor (Clavien-Dindo grade I and II) and similar between the two groups: two patients in the high BMI group developed a seroma versus three patients in the low BMI group (11.11% vs. 9.38%, p=1.00).
There was no difference in ER visits between the two cohorts (5.56% high BMI vs 6.25% low BMI, p= 1.00). One patient in the low BMI group had exertional dyspnea with a negative workup. Otherwise, remaining ER visits were related to pain secondary to a seroma. There were no early hernia recurrences 3-months post-operatively in either group.
Conclusion: Our data shows improved outcomes in patient with BMI ≥35 kg/m2 who underwent robotic eTEP procedure. Further study may be necessary with larger number of patients to validate the long-term benefits of robotic eTEP for VHR in morbidly obese patients.
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