Background

Robotic surgery has been increasingly utilized in the approach to ventral hernia repairs, as it allows for ease of suturing to the anterior abdominal wall. We explored the outcomes based on surgical approach to concomitant bariatric surgery with ventral hernia repair.

Methods

This is a retrospective cohort study from MBSAQIP data from the years 2015-2022. Inclusion criteria were adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) while also undergoing repair of a ventral hernia based on CPT codes. Patients were compared via surgical approach (laparoscopic vs. robotic) for the primary outcome of 30-day post-operative complications, defined as a composite of sepsis, DVT/PE, intubation, anastomotic leak, bleed, UTI, wound infection, renal failure, pneumonia and mortality. Univariable and multivariable logistic regressions were performed for the primary outcome.

Results

26,961 patients were included, of which robotic surgery was utilized in 16.8% and laparoscopy in 83.2%. Robotic approaches became increasingly common over time with 23% performed in 2022 versus 7.7% in 2015 (p<0.01, Figure). Operative time for the robotic approach averaged 26.3 minutes longer than laparoscopic (p<0.01). Additionally, patients having robotic surgery were more likely to have a third concomitant procedure (66.6% vs 57.2, p<0.01). After controlling for confounders (Table), variables with the greatest odds of developing the composite complication outcome included RYGB, prior surgery, and preoperative anticoagulation therapy; however, the odds of the composite 30-day outcome did not differ between surgical approaches.

Conclusions

Robotic and laparoscopic approaches to concomitant bariatric surgery and ventral hernia repair have comparable 30-day post-operative outcomes.