Robotic ventral hernia repair in morbidly obese patients: perioperative and mid-term outcomes

Background: Obesity is a growing epidemic and it has been found to be an independent risk factor for a multitude of perioperative complications. We describe our experience with morbidly obese patients who underwent robotic ventral hernia repair (RVHR), examining factors affecting perioperative and mid-term outcomes. Methods: From a prospectively maintained database, all morbid obese (BMI ≥ 40 kg/m²) patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and the mid-term follow-up. Complications were assessed with validated grading systems and index. Univariate analyses and multivariate logistic regression analysis were performed to determine the factors associated with the development of any complication. Kaplan–Meier’s time-to-event analysis was performed to calculate freedom-of-recurrence. Results: Fifty patients with median BMI 42.9 kg/m²were included. The median last pain score before leaving PACU was 4. The mean LOS of all cohorts was 0.32 day. The postoperative complication rate was 46%. The most frequent complication was persistent pain/discomfort (32%) in early postoperative period. Minor complications (Clavien–Dindo grade-I and II) were seen in 40% of patients while major complications (Clavien–Dindo grade-III and IV) were seen in 6%. The maximum comprehensive complication index® score was 42.9. In regression analysis, BMI, adhesiolysis, intraperitoneal mesh placement, and off-console time were found to be significantly associated with postoperative complications. Mean follow-up was 22.7 months. Hernia recurrence was seen in 2% and the mean freedom-of-recurrence was 57.4 months (95% CI 54.6–60.2). Conclusions: To our best knowledge, this study is the first to present outcomes of morbidly obese patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in morbid obesity with a low recurrence rate as well as a long freedom-of-recurrence time. Further studies are needed to better elucidate the role of robotic surgery in morbidly obese patients.