Pushing the boundary: the incidence of complications and recurrences following robotic eTEP in BMI ≥ 35 versus BMI < 35 patients.

Background: Obesity not only contributes to the pathology of primary and incisional ventral hernias but is also associated with increased rates of post-operative complications and hernia recurrence after repair. Whether this holds true for complex robotic eTEP retrorectus hernia repair has not been well researched. The aim of this study was to determine whether obesity increases risks of short-term recurrence or complications after robotic abdominal wall reconstruction.

Methods: A retrospective chart review was performed for 102 robotic eTEP abdominal wall reconstructions completed at a single institution between 2019 and 2022. Independent variables included patient demographics, hernia characteristics, and intraoperative data. Primary outcomes included 30-day post-operative complications resulting in readmission/ED visits. Outcomes were compared between two cohorts: BMI < 35 and BMI ≥ 35. Univariate analysis was used to compare the incidence of complications between both groups.

Results: Our mean follow-up time was 59.2 +/- 98.7 days, and median was 18 days, with the range of 6-419 days. Of the 102 patients, the overall mean BMI was 32.1. 31 patients (30%) had a BMI ≥ 35, while 71 (70%) had a BMI < 35. The BMI ≥ 35 cohort had a mean BMI of 37.9, and the BMI < 35 cohort had a BMI of 29.6. There were no recurrences in the BMI ≥ 35 group and only one in the BMI < 35 group (0% vs. 1.4%, p = 0.51, 95% CI - 0.06 to 0.03). There were two complications in the BMI ≥ 35 group, and seven in the BMI < 35 group (6.5% vs. 9.9%, p = 0.58, 95% CI - 0.17 to 0.11).

Conclusions: The results of our single-center experience showed no significant increase in 30-day hernia recurrence or surgical site occurrences for patients with BMI ≥ 35 undergoing robotic eTEP. This study is limited by small patient cohort size and short follow-up interval.