Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial

Jeremy A Warren; Dawn Blackhurst; Joseph A Ewing; Alfredo M Carbonell

doi:10.1007/s00464-024-11202-1

Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial

Surg Endosc. 2024 Dec;38(12):7466-7474. doi: 10.1007/s00464-024-11202-1. Epub 2024 Sep 12.

Authors

Jeremy A Warren¹, Dawn Blackhurst², Joseph A Ewing³, Alfredo M Carbonell⁴

Affiliations

¹ Prisma Health Department of Surgery, University of South Carolina School of Medicine Greenville, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA. Jeremy.warren@prismahealth.org.
² Prisma Health Research Administration, Greenville, SC, USA.
³ Health Sciences Center, Prisma Health Upstate, Greenville, SC, USA.
⁴ Prisma Health Department of Surgery, University of South Carolina School of Medicine Greenville, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA.

Abstract

Background: Robotic retromuscular ventral hernia repair (rRMVHR) potentially combines the best features of open and minimally invasive VHR: myofascial release with abdominal wall reconstruction (AWR) with the lower wound morbidity of laparoscopic VHR. Proliferation of this technique has outpaced the data supporting this claim. We report 2-year outcomes of the first randomized controlled trial of oRMVHR vs rRMVHR.

Methods: Single-center randomized control trial of open vs rRMVHR. 100 patients were randomized (50 open, 50 robotic). We included patients > 18 y/o with hernias 7-15 cm with at least one of the following: diabetes, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥ 30, or current smokers. Primary outcome was occurrence of a composite outcome of surgical site infection (SSI), non-seroma surgical site occurrence (SSO), readmission, or hernia recurrence. Secondary outcomes were length of stay, any SSI or SSO, SSI/SSOPI, operative time, patient reported quality of life, and cost. Analysis was performed in an intention-to-treat fashion. Study was funded by a grant from Society of American Gastrointestinal and Endoscopic Surgeons.

Results: 90 patients were available for 30-day and 62 for 2-year analysis (rRMVHR = 46 and 32, oRMVHR = 44 and 30). Hernias in the open group were slightly larger (10 vs 8 cm, p = 0.024) and more likely to have prior mesh (36.4 vs 15.2%; p = 0.030), but were similar in length, prior hernia repairs, mesh use, and myofascial release. There was no difference in primary composite outcome between oRMVHR and rRMVHR (20.5 vs 19.6%, p = 1.000). Median length of stay was shorter for rRMVHR (1 vs 2 days; p < 0.001). All patients had significant improvement in quality of life at 1 and 2 years. Other secondary outcomes were similar.

Conclusion: There is no difference in a composite outcome including SSI, SSOPI, readmission, and hernia recurrence between open and robotic RMVHR.

Keywords: Open retromuscular hernia repair; Randomized controlled trial; Robotic retromuscular hernia repair; Robotic ventral hernia.

Publication types

Randomized Controlled Trial
Comparative Study

MeSH terms

Adult
Aged
Female
Hernia, Ventral* / surgery
Herniorrhaphy* / methods
Humans
Laparoscopy / methods
Length of Stay / statistics & numerical data
Male
Middle Aged
Operative Time
Patient Readmission / statistics & numerical data
Prospective Studies
Quality of Life
Recurrence
Robotic Surgical Procedures* / methods
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Treatment Outcome