Abstract
Background
Controversy exists regarding the safety and effectiveness of minimally invasive inguinal hernia repairs in patients with a history of prior urologic pelvic operations (PUPO), such as a prostatectomy, which causes scarring and disruption of the retropubic tissue planes. Our study sought to examine whether a history of PUPO impacts surgical outcomes in males undergoing robotic-assisted inguinal hernia repair.
Methods
The Americas Hernia Society Quality Collaborative (AHSQC) database was queried to identify male patients who underwent a robotic inguinal hernia repair with 30-day follow-up. A sub-query was performed to identify subjects within the cohort with a documented history of PUPO. Propensity score matching was subsequently utilized to evaluate for differences in intra-operative complications and short-term post-operative outcomes.
Results
In total, 1664 male patients underwent robotic-assisted inguinal hernia repair, of whom 65 (3.9%) had a PUPO. After a 3:1 propensity score matching with hernia repair patients who did not have prior procedures, 195 (11.7%) males were included in the comparison cohort. There were no documented vascular, bladder, or spermatic cord injuries in either group. There was no difference in 30-day readmission rate (5% vs. 3%, respectively, p = 0.41). No hernia recurrences were recorded within the 30-day follow-up period in either group. There was no statistical difference in post-operative complications (including seroma formation, hematoma, and surgical site occurrences) between the two groups (14% vs. 8%, p = 0.18).
Conclusions
In an experienced surgeon’s hands, robotic-assisted minimally invasive inguinal hernia repair may be an alternative to open repair in patients with PUPO who were previously thought to be poor minimally invasive surgical candidates.
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Anthony Iacco serves as a proctoring consultant for Intuitive Surgical, Inc. Andrew Angus and Alexander DeMare have no conflicts of interest or financial ties to disclose.
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Angus, A., DeMare, A. & Iacco, A. Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database. Surg Endosc 35, 5310–5314 (2021). https://doi.org/10.1007/s00464-020-08020-6
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DOI: https://doi.org/10.1007/s00464-020-08020-6