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.
P069: ROBOTIC REPAIR OF NON-MIDLINE ABDOMINAL WALL HERNIAS
Alyssa Guo; Jeremy A Warren, MD, FACS; University of South Carolina School of Medicine Greenville
Introduction: There are numerous potential etiologies for non-midline ventral hernias. Hernias may occur subcostal, flank, or trocar site incisions, after blunt trauma, or as primary hernias. Achieving defect closure and adequate mesh reinforcement often requires utilizing sometimes unfamiliar tissue planes in the lateral abdominal wall and retroperitoneum. The robotic platform provides excellent visualization enhances the ability to dissect the layers of the abdominal wall, close the hernia defect, and widely reinforce the repair with mesh. We report a series of non-midline hernia repairs performed robotically.
Methods: A prospectively maintained hernia registry data (Americas Hernia Society Quality Collaborative, AHSQC) was queried for all robotic lateral abdominal wall hernia repairs at our institution. Surgical technique and clinical outcomes, including complications, surgical site infection (SSI), surgical site occurrence (SSO), and hernia recurrence are reported.
Results: We identified 75 patients with non-midline hernias. Hernias occurred after urologic procedures (n=8), spine procedures (n=3), parastomal (n=11), prior ostomy site (n=15), trauma (n=6), or other incisional (n=27). Mean hernia width was 9.1cm. Repair was performed using a transabdominal retromuscular (rRM) approach in 28 patients, transabdominal preperitoneal (rTAPP) in 23, extended view totally extraperitoneal (eTEP) in 21, and intraperitoneal onlay of mesh (IPOM) in 3. Conversion to open was required in 10 cases (13.3%). Fascial closure was achieved in 96% of cases. SSI occurred in 4 (5.3%), all treated with antibiotics and one requiring wound opening. No mesh infections occurred. SSO occurred in 30 (40%), 26 of which were seromas and only 3 requiring intervention. Hernias recurred in 2 patients (2.7%) with mean follow-up of 8 mos.
Conclusion: Non-midline hernias can be readily approached using the robotic platform. The ability to dissect the musculofascial and peritoneal layers of the abdominal wall allows for mobilization of the abdominal wall for defect closure and wide mesh overlap, ideally in an extraperitoneal position.
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