Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database.
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.
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. 2021 Sep;35(9):5310-5314. doi: 10.1007/s00464-020-08020-6. Epub 2020 Oct 1. PMID: 33006032.