Robotic Inguinal Hernias Performed at a Community Hospital: a Case Series of 292 Patients

Background: Robotic inguinal hernia repair has become more common and has replaced the laparoscopic approach in many hospitals in the US. We present a retrospective review of 416 consecutive inguinal hernia repairs using the robotic transabdominal preperitoneal approach in an academic community hospital. Methods: This is a retrospective review of 416 consecutive robotic inguinal hernia repairs in 292 patients performed from October 2015 to March 2021 by two surgeons. The demographics, intra-operative findings, and postoperative outcomes were analyzed. The results for patients during the initial 25 cases (which were considered to be during the learning curve for each surgeon) were compared to their subsequent cases. A multivariable logistic regression analysis was used to determine independent risk factors for postoperative complications. Results: Overall, 292 patients underwent 416 inguinal hernia repairs, of whom 124 (42.5%) had bilateral hernias. The mean age was 61 years and the mean BMI was 26.96 kg/m2. Of the bilateral hernias, 31.5% were unsuspected pre-operatively. Femoral hernias were found in 20.5% of patients, including in 18.4% of men, which were also unsuspected. Post-operatively, 89% of patients were discharged home the same day. The most common post-operative complication was seroma, which occurred in 13%. Three patients required re-intervention: one had deep SSI (infected mesh removal), one had a needle aspiration of a hematoma (SSORI), and one was operated on for small bowel volvulus related to adhesions. On short-term follow-up, there was only one early recurrence (0.2%). When cases during the learning curve period were compared to subsequent surgeries, there were no major differences in post-operative complications or operating time. Patients aged ≥55 years had a 2.456-fold (p=0.023) increased odds of post-operative complications. Conclusions: Robotic inguinal hernia repair can be safely performed at a community hospital with few early post-operative complications and very low early recurrence rates. The robotic approach also allows for the detection of a significant number of unsuspected contralateral inguinal hernias and femoral hernias, especially in male patients. Age ≥55 years was an independent risk factor for postoperative complications.