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P019: PERIOPERATIVE INFECTIOUS OUTCOMES OF ROBOTIC VERSUS OPEN TRANSVERSUS ABDOMINIS RELEASE
Bradley Kushner, MD; Margaret Sehnert, RHIA; Sara Holden, MD; Jeffrey Blatnik, MD, FACS; Washington University in St. Louis
Introduction: Transversus Abdominis Release (TAR) has proven to be an effective and safe procedure for the repair of complex ventral hernias. It provides significant myofascial advancement, linea alba restoration, and a well-vascularized plane for sublay mesh placement. However, open TARs (O-TAR) are associated with high rates of perioperative wound morbidity, with up to 27-41% of patients suffering wound complications. The robotic TAR (R-TAR) has emerged as a viable minimally invasive alterative. Our aim was to evaluate postoperative infectious complications in a large cohort of patients undergoing either O-TAR or R-TAR.
Methods: This was a retrospective cohort study of patients who underwent either an O-TAR or R-TAR by two fellowship-trained abdominal wall specialists at a quaternary care academic medical center from January 2018 to February 2020. Both surgeons utilized similar surgical techniques for the O-TAR and R-TAR. Electronic health records were analyzed for demographic information (age, body mass index (BMI)), perioperative clinical data (operating time (OT), length of hospital stay (LOS), and hernia defect size), and for infectious complications (surgical site occurrence (SSO) at 30 days, abdominal wall or deep abscesses, seromas/hematomas, wound cellulitis, surgical site occurrence requiring procedural intervention (SSOPI), antibiotic prescription, and 30-day readmission rate). Surgical site infections (SSI) were calculated from the number of SSOs minus the number of seromas/hematomas. Exclusion criteria were patients undergoing combined procedures (i.e. colorectal, gynecological, and urological), patients repaired with biologic mesh, robotic enhanced-view totally extraperitoneal (eTEP) repairs, robotic pre-peritoneal repairs, and patients who did not have at least one post-operative visit. Robotic converted to O-TARs were analyzed as a part of the O-TAR cohort. The Mann-Whitney U test was used to analyze demographical data and infectious data was evaluated with the Chi-Square test (significance set at 0.05).
Results: A total of 236 patients were included in the analysis (143 O-TARs; 93 R-TARs). Permanent synthetic polypropylene mesh was used in all patients, except one who was repaired with biosynthetic mesh. Three patients required conversion from robotic to an open procedure all secondary to dense intraperitoneal adhesions formed from prior abdominal surgeries. Baseline demographics for O-TAR versus R-TAR are as follows: Age (yrs.): 58.6 vs. 60.0 (p=0.16); BMI (kg/m2): 32.5 vs. 30.9 (p=0.02), and defect size (cm2): 339.3 vs. 133.6 (p<0.001). Both OT (minutes) and LOS (days) were significantly longer with O-TAR (OT: 319.4 vs. 307.3 (p<0.04); LOS: 4.8 vs. 1.9 (p<0.001)). O-TAR, compared with R-TAR, had statistically higher rates of the following infectious complications: SSO: 21.7% vs. 10.8% (p=0.03); SSI: 9.8% vs. 1.1% (p=0.007); cellulitis: 11.2% vs. 1.1% (p=0.003); 30-day readmission: 7.9% vs. 0% (p<0.02); and antibiotic prescription: 18.2% vs. 1.1% (p<0.001). There were no statistical differences in rates of seroma/hematoma (11.9% vs. 9.7%: p=0.60), abscess (4.2% vs. 1.1%: p=0.17), and SSOPI (5.6% vs. 2.2%: p=0.20).
Conclusions: For patients with small to medium sized hernia defects that require an abdominal wall reconstruction, a R-TAR provides an effective and reliable alterative to an O-TAR. In experienced hands, R-TAR significantly reduces patient’s infectious and wound morbidity and is associated with shorter operative times and hospitalizations.
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