Robotic Inguinal Hernia Repair Compared to Open and Laparoscopic Repair: A National Database Review

Abstract

Introduction Robotic inguinal hernia repair (RIHR) has been previously compared to laparoscopic (LIHR) and open (OIHR) approaches and found to be safe and effective. However, recent analysis utilizing large national databases is limited. Objective To compare the outcomes of RIHR to LIHR and OIHR, including morbidity, mortality and operative time. Participants The 2022 ACS National Surgical Quality Improvement database was queried to identify all adult patients with a diagnosis of inguinal hernia who underwent an elective RIHR, LIHR or OIHR. Chi-square and Fisher’s exact tests were used to analyze the categorical data and ANOVA was utilized to analyze continuous variables. Results Among 27 755 patients, 7306 underwent RIHR. The robotic approach had the highest average BMI (mean RIHR 27.4 vs LIHR 26.7 vs OIHR 26.0 P =< .001). RIHR was found to be independently associated with longer operative time in multivariate linear regression when compared to the other platforms (LIHR β + −16.894, 95% CI −18.251: −15.538, P = .001 vs OIHR β + −12.056, 95% CI −13.260: −10.852, P = .001). In multivariate logistic regression, approach was not independently associated with mortality (LIHR AOR 0.631, P = .707 vs OIHR. (AOR 3.29, P = .112). However, surgical approach was found to have an independent risk of overall morbidity when compared to OIHR (RIHR AOR 0.702 P = .01 vs LIHR AOR 0.702 P = .01). Conclusion In this retrospective study, RIHR is shown to have equivalent morbidity and mortality with longer operative times compared to the other approaches in both initial and recurrent unilateral and bilateral inguinal hernias.