Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P068: ROBOTIC EXTENDED-VIEW TOTALLY EXTRAPERITONEAL (ETEP) REPAIR OF ABDOMINAL WALL HERNIAS
Wes Love, MD; Jeremy A Warren, MD, FACS; University of South Carolina School of Medicine Greenville
Introduction: Utilization of the robotic platform for ventral hernia repair has seen exponential growth in recent years. Perhaps the greatest potential advantage of this technology is the ability to recreate complex techniques traditionally performed open in a minimally invasive fashion. In our practice, the technique has evolved from a transabdominal retromuscular approach, which is primarily restricted to hernias of the superior or inferior abdominal wall, to a double-dock approach using bilateral transversus abdominis myofascial release (TAR), to the eTEP approach. The eTEP approach expands the indications for robotic hernia repair and offers a step-wise approach to myofascial release for retromuscular ventral hernia repair. We report our series of eTEP VHR.
Methods: A prospectively maintained hernia registry data (Americas Hernia Society Quality Collaborative, AHSQC) was queried for all robotic VHR repairs at our institution. Chart review was then performed to confirm surgical approach as eTEP, a variable not specifically captured in the AHSQC. Surgical technique and clinical outcomes, including complications, surgical site infection (SSI), surgical site occurrence (SSO), and hernia recurrence are reported.
Results: We identified 178 patients repaired with the eTEP approach. Patient mean BMI was 36.2, 18.5% were active smokers, 26.5% were diabetic, and 13.4% had COPD. Mean defect width was 7.6cm (area 100.8 cm2) and mean mesh area was 585 cm2. Mesh was placed in the retromuscular position in all cases, and TAR was required in 20.2% (n=36) in order to achieve fascial closure and/or provide adequate mesh overlap of the defect. Fascial closure was achieved in all but one case. The rate of SSI was 2.8%, with 1 patient requiring wound opening and all treated with antibiotics, and the rate fo SSO was 50.6%, 94% of which were seromas. Percutaneous drainage was required in 7 patients. No mesh infections occurred and no mesh removal was required. Median length of stay was 0 days (mean 1 day).
Conclusion: Robotic eTEP VHR allows reconstruction of the abdominal wall using a retromuscular approach, with additional lateral myofascial release if necessary, in a minimally invasive fashion. Infection rate is quite low, and patients are routinely discharged on the day of surgery. Long-term follow-up is needed to determine the durability of this approach.
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