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Kudsi OY, Gokcal F, Bou-Ayash N, Chang K. Comparison of Midterm Outcomes Between Open and Robotic Emergent Ventral Hernia Repair. Surg Innov 2020; 28:449-457. [PMID: 33135558 DOI: 10.1177/1553350620971182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. There are no studies on the role of robotics in emergency ventral hernia repair (EVHR). We aimed to compare outcomes of robotic EVHR (REVHR) and open (OEVHR). Methods. We performed a retrospective study of EVHRs performed between 2013 and 2019. Patients who underwent ventral hernia repair in an elective setting and patients who had concomitant non-abdominal wall procedures were excluded. Pre-, intra-, and postoperative variables were compared. Univariate and multivariate analyses were performed. Results. In all, 43 patients underwent OEVHR as compared to 35 patients who underwent REVHR. The patients in both groups were similar in terms of hernia etiology as well as Acute Physiology and Chronic Health Evaluation (APACHE-II) and the Sequential Organ Failure Assessment (SOFA) scores. Mean operative times for the robotic group were almost 2-fold compared with those of the open group (139 minutes vs 70 minutes, respectively; P < .001). Median length of stay (LOS) did not differ between the groups (3 days for both groups; P = .488). Major complications (P = .001), morbidity scores (P = .006), surgical site events (SSEs) (P = .045), and procedural interventions (P = .020) were found higher in the open group. No differences in freedom of recurrence were found (P = .662). Multivariate logistic regression analysis showed that open repair was associated with a 4-fold risk for the development of complications as compared to robotic repair (P = .025; odds ratio (OR) = 4, 95% confidence interval (CI) = 1.193-13.444). Conclusion. Compared to OEVHR, REVHR resulted in longer operative times and lower morbidity, including SSEs and related interventions. However, neither LOS nor recurrence differed between the groups.
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Affiliation(s)
- Omar Y Kudsi
- Department of Surgery, Good Samaritan Medical Center, School of Medicine, 12261Tufts University, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, School of Medicine, 12261Tufts University, USA
| | - Naseem Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, School of Medicine, 12261Tufts University, USA
| | - Karen Chang
- Department of Surgery, Good Samaritan Medical Center, School of Medicine, 12261Tufts University, USA
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Gianchandani Moorjani R, Díaz García A, Rosat Rodrigo A, Barrera Gómez M. Use of ICG to evaluate the viability of intestine during laparoscopic transabdominal hernioplasty in emergency surgery of incarcerated hernia. Cir Esp 2020; 99:313-314. [PMID: 32563564 DOI: 10.1016/j.ciresp.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Rajesh Gianchandani Moorjani
- Servicio de Cirugía General y Digestiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Alberto Díaz García
- Servicio de Cirugía General y Digestiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Adriá Rosat Rodrigo
- Servicio de Cirugía General y Digestiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Manuel Barrera Gómez
- Servicio de Cirugía General y Digestiva, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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Kohga A, Kawabe A, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K. Emergency surgery versus elective surgery after reduction for patients with incarcerated groin hernias. ANZ J Surg 2020; 90:1086-1091. [DOI: 10.1111/ans.15877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Atsushi Kohga
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Akihiro Kawabe
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Kiyoshige Yajima
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Takuya Okumura
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | | | - Jun Isogaki
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Kenji Suzuki
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
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Azin A, Hirpara D, Jackson T, Okrainec A, Elnahas A, Chadi SA, Quereshy FA. Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc 2018; 33:2812-2820. [PMID: 30421078 DOI: 10.1007/s00464-018-6573-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/01/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND The safety of emergent laparoscopic repair of incarcerated ventral hernias is not well established. The objective of this study was to determine if emergent laparoscopic repair of incarcerated ventral hernias is comparable to open repair with respect to short-term clinical outcomes. METHODS Patients undergoing emergency repair of an incarcerated ventral hernia with associated obstruction and/or gangrene were identified using the ACS-NSQIP 2012-2016 dataset. One-to-one coarsened exact matching (CEM) was conducted between patients undergoing laparoscopic and open repair. Matched cohorts were compared with respect to morbidity, mortality, readmission, reoperation, missed enterotomies, and length of stay. Missed enterotomy was defined as any re-operative procedure within 30 days that required resection of large or small bowel segments, based on CPT codes. Multivariate analysis was conducted to determine adjusted predictors of morbidity. RESULTS A total of 1642 patients were identified after CEM. Laparoscopic compared to open repair was associated with a lower rate of 30-day wound-morbidity (OR 0.35, 95% CI 0.22-0.57, p < 0.001). Laparoscopic repair was not associated with lower 30-day non-wound morbidity (OR 0.73, 95% CI 0.51-1.06, p = 0.094). Laparoscopic repair was associated with shorter LOS (3.6 days vs. 4.3 days, p = 0.014). A higher rate of missed enterotomies was observed in the laparoscopic cohort (0.7% vs. 0.0%, p = 0.031). There were no group differences with respect to 30-day readmission, reoperation, or mortality. CONCLUSIONS Emergency laparoscopic repair of incarcerated ventral hernias is associated with lower rates of wound-morbidity and shorter hospital stays compared to open repair. However, laparoscopic repair is associated with a higher rate of missed enterotomies; a rate which is low and comparable to elective non-incarcerated ventral hernia repairs.
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Affiliation(s)
- Arash Azin
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Dhruvin Hirpara
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Ahmad Elnahas
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Sami A Chadi
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Fayez A Quereshy
- Division of General Surgery, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, University Health Network, Toronto, ON, Canada. .,Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 8MP-320, Toronto, ON, M5T 2S8, Canada.
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