Trends and Outcomes of Open, Laparoscopic, and Robotic Inguinal Hernia Repair in the Veterans Affairs System

Overview

Journal Hernia

Publisher Springer

Date 2021 Apr 28

PMID 33909151

Citations 8

Authors

T J Holleran

M A Napolitano

A D Sparks

J E Duncan

M Garrett

F J Brody

Affiliations

Soon will be listed here.

Abstract

Purpose: Robotic inguinal hernia repair (RHR) is an evolving technique but is comparatively expensive and has yet to show superior outcomes versus open (OHR) or laparoscopic (LHR) approaches. The utilization and clinical outcomes of RHR have not been reported within the veterans affairs (VA) system. This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans.

Methods: This is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported.

Results: From 2008-2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Compared to LHR, RHR was associated with 4.94 times higher odds of complications, 100 min longer mean operative time, and 1.5 days longer median length of stay (LOS). Compared to OHR, RHR was associated with 5.92 times higher odds of complications, 57 min longer mean operative time, and 1.1 days longer median LOS. Utilization of RHR and LHR significantly increased over time. RHR complication rates decreased over time (2008: 20.8% to 2019: 3.2%) along with mean operative times (2008: 4.9 h to 2019: 2.8 h; p < 0.05).

Conclusion: While this study demonstrated inferior outcomes after RHR, the temporal trends are encouraging. This may be due to increased surgeon experience with robotics. Further prospective data will elucidate the role of RHR as this technique increases.

Citing Articles

A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century.

Huerta S, Garza A J Clin Med. 2025; 14(3).

PMID: 39941661 PMC: 11818799. DOI: 10.3390/jcm14030990.

Comparing Robot-Assisted and Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

Khewater T, Al Madshush A, Altidlawi M, Faya H, Alanazi M, Alqahtani M Cureus. 2024; 16(5):e60959.

PMID: 38910645 PMC: 11193849. DOI: 10.7759/cureus.60959.

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair.

Woo K, Ellis R, Maskal S, Remulla D, Shukla P, Rosen A Surg Endosc. 2024; 38(6):3433-3440.

PMID: 38710888 PMC: 11133107. DOI: 10.1007/s00464-024-10866-z.

Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs.

Halpern A, Klein M, McSweeney B, Tran H, Ganguli S, Haney V Surg Endosc. 2024; 38(5):2344-2349.

PMID: 38632119 DOI: 10.1007/s00464-024-10805-y.

Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis.

DeAngelis N, Schena C, Moszkowicz D, Kuperas C, Fara R, Gaujoux S Surg Endosc. 2023; 38(1):24-46.

PMID: 37985490 DOI: 10.1007/s00464-023-10545-5.

References

Berndsen M, Gudbjartsson T, Berndsen F . [Inguinal hernia - review]. Laeknabladid. 2019; 105(9):385-391. DOI: 10.17992/lbl.2019.09.247. View

Kockerling F, Simons M . Current Concepts of Inguinal Hernia Repair. Visc Med. 2018; 34(2):145-150. PMC: 5981671. DOI: 10.1159/000487278. View

LICHTENSTEIN M . The custom-tailored inguinal hernia repair. J Okla State Med Assoc. 1954; 47(8):222-4. View

Liem M, van Vroonhoven T . Laparoscopic inguinal hernia repair. Br J Surg. 1996; 83(9):1197-1204. View

Wei F, Zhang Y, Han W, Zhang Y, Shao Y, Ni R . Transabdominal Preperitoneal (TAPP) Versus Totally Extraperitoneal (TEP) for Laparoscopic Hernia Repair: A Meta-Analysis. Surg Laparosc Endosc Percutan Tech. 2015; 25(5):375-83. DOI: 10.1097/SLE.0000000000000123. View

Birth M, Friedman R, Melullis M, Weiser H . Laparoscopic transabdominal preperitoneal hernioplasty: results of 1000 consecutive cases. J Laparoendosc Surg. 1996; 6(5):293-300. DOI: 10.1089/lps.1996.6.293. View

Tanphiphat C, Tanprayoon T, Sangsubhan C, Chatamra K . Laparoscopic vs open inguinal hernia repair. A randomized, controlled trial. Surg Endosc. 1998; 12(6):846-51. DOI: 10.1007/s004649900727. View

Trevisonno M, Kaneva P, Watanabe Y, Fried G, Feldman L, Andalib A . Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia. 2015; 19(5):725-33. DOI: 10.1007/s10029-015-1358-5. View

Tadaki C, Lomelin D, Simorov A, Jones R, Humphreys M, Dasilva M . Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair. Hernia. 2016; 20(3):399-404. DOI: 10.1007/s10029-016-1465-y. View

10.

Perez A, Strassle P, Sadava E, Gaber C, Schlottmann F . Nationwide Analysis of Inpatient Laparoscopic Versus Open Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A. 2020; 30(3):292-298. DOI: 10.1089/lap.2019.0656. View

11.

Tian W, Fei Y . [Application of Da Vinci robotic surgery to hernia repair]. Zhonghua Wei Chang Wai Ke Za Zhi. 2018; 21(7):740-743. View

12.

Sheetz K, Claflin J, Dimick J . Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open. 2020; 3(1):e1918911. PMC: 6991252. DOI: 10.1001/jamanetworkopen.2019.18911. View

13.

Charles E, Mehaffey J, Tache-Leon C, Hallowell P, Sawyer R, Yang Z . Inguinal hernia repair: is there a benefit to using the robot?. Surg Endosc. 2017; 32(4):2131-2136. PMC: 10740385. DOI: 10.1007/s00464-017-5911-4. View

14.

Khoraki J, Gomez P, Mazzini G, Pessoa B, Browning M, Aquilina G . Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair. Surg Endosc. 2019; 34(8):3496-3507. DOI: 10.1007/s00464-019-07128-8. View

15.

Kakiashvili E, Bez M, Abu Shakra I, Ganam S, Bickel A, Merei F . Robotic inguinal hernia repair: Is it a new era in the management of inguinal hernia?. Asian J Surg. 2020; 44(1):93-98. DOI: 10.1016/j.asjsur.2020.03.015. View

16.

Aiolfi A, Cavalli M, Micheletto G, Lombardo F, Bonitta G, Morlacchi A . Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia. 2019; 23(3):473-484. DOI: 10.1007/s10029-019-01964-2. View

17.

Abdelmoaty W, Dunst C, Neighorn C, Swanstrom L, Hammill C . Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis. Surg Endosc. 2018; 33(10):3436-3443. DOI: 10.1007/s00464-018-06606-9. View

18.

Prabhu A, Carbonell A, Hope W, Warren J, Higgins R, Jacob B . Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial. JAMA Surg. 2020; 155(5):380-387. PMC: 7081145. DOI: 10.1001/jamasurg.2020.0034. View

19.

Odani S, Agaku I, Graffunder C, Tynan M, Armour B . Tobacco Product Use Among Military Veterans - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2018; 67(1):7-12. PMC: 5769800. DOI: 10.15585/mmwr.mm6701a2. View

20.

Kudsi O, McCarty J, Paluvoi N, Mabardy A . Transition from Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair to Robotic Transabdominal Preperitoneal Inguinal Hernia Repair: A Retrospective Review of a Single Surgeon's Experience. World J Surg. 2017; 41(9):2251-2257. DOI: 10.1007/s00268-017-3998-3. View