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

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

Jeremy A Warren  1 , Dawn Blackhurst  2 , Joseph A Ewing  3 , Alfredo M Carbonell  4
Affiliations
Randomized Controlled Trial

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

Jeremy A Warren et al. Surg Endosc. 2024 Dec.

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.

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Conflict of interest statement

Declarations. Disclosures: Warren and Carbonell have received honoraria or consulting fees from Intuitive Surgical in the last 36 months. Warren has received honoraria for speaking from Ethicon/Johnson & Johnson and participated in a Data Safety Monitoring Board for REBUILD (unpaid) in the last 36 months. Carbonell has received consulting fees from Deep Blue Medical and participated in a Data Safety Monitoring Board for Medtronic in the last 36 months. Ewing and Blackhurst have no conflicts of interest.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
See this image and copyright information in PMC

References

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