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A comparison of outcomes between class-II and class-III obese patients undergoing robotic ventral hernia repair: a multicenter study

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Abstract

Background

Morbid obesity has been considered a contraindication to ventral hernia repair (VHR) in the past. However, the relationship between a greater body mass index (BMI) and adverse outcomes has yet to be established in the minimally invasive sphere, particularly with robotics, which may offer an effective surgical option in these high-risk patients. We sought to investigate this relationship by comparing the outcomes of class-II (BMI: 35–39.9 kg/m2) and class-III (BMI: ≥ 40 kg/m2) obese patients after robotic VHR (RVHR).

Methods

Data were analyzed from two centers and six surgeons who performed RVHR between 2013 and 2020. Patients with a BMI > 35 kg/m2 were included in the study. A 1:1 propensity score match (PSM) analysis was conducted to obtain balanced groups and univariate analyses were conducted to compare the two groups across preoperative, intraoperative, and post-operative timeframes. Postoperative complications and morbidity were reported according to the Clavien-Dindo Classification and comprehensive complication index (CCI®) systems.

Results

From an initial cohort of 815 patients, 228 patients with a mean BMI of 39.7 kg/m2 were included in the study. PSM analysis stratified these into 69 patients for each of the class-II and class-III groups. When comparing matched groups, there were no differences in any of the variables across all timeframes, except for a higher rate of Polytetrafluoroethylene (PTFE)-based mesh use in the class-III group (39.1% vs 17.4%, p = 0.008). The estimated recurrence-free time was 76.4 months (95% CI = 72.5–80.4) for the class-II group and 80.4 months (95% CI = 78–82.8) for the class-III group.

Conclusion

This multicenter study showed no difference in outcomes after RVHR between matched class-II and class-III obese patients.

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Availability of data and material

Data available upon reasonable request.

Code availability

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Authors and Affiliations

  1. Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA

    O. Y. Kudsi, F. Gokcal & N. Bou-Ayash

  2. Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA

    E. Watters, X. Pereira, D. L. Lima & F. Malcher

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  1. O. Y. Kudsi
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  2. F. Gokcal
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Corresponding author

Correspondence to O. Y. Kudsi.

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Conflict of interest

Dr. Kudsi receives a teaching and consultancy related fees from Intuitive, Gore, unrelated to the present study. Dr. Malcher receives consultancy related fees from Intuitive, BD/Bard, Medtronic, ACell, unrelated to the present study. Drs. Gokcal, Bou-Ayash, Watters, Pereira, and Lima have no COIs or financial ties to disclose.

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The database used for this study approved by the Institutional Review Board.

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Informed consent was obtained from all participants.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kudsi, O.Y., Gokcal, F., Bou-Ayash, N. et al. A comparison of outcomes between class-II and class-III obese patients undergoing robotic ventral hernia repair: a multicenter study. Hernia 26, 1531–1539 (2022). https://doi.org/10.1007/s10029-022-02594-x

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