The Effect of Robotics in the Perioperative Outcomes of Hernia Repair in Morbidly Obese Patients

Abstract Aim To show that robotic hernia surgery in morbidly obese patients is feasible. Surgery is often denied in the fear of complications associated with obesity. Consequently, obese patients are over-represented in those requiring emergent repair. Methods From a prospective database, all patients with body mass index (BMI) ≥40 kg/m2 operated during 1.3.2022–25.1.2024 were analyzed. Robotic repair is our standard procedure for ventral hernias since 1.3.2022. Open surgery is still common in emergency cases. Results 62 patients with BMI ≥40 (median 44.7, range 40–67) were operated for primary (n = 44, robotic 23) or incisional (n = 18, robotic 8) hernia. 32/62 (52%) were emergency/urgent operations (robotic 10, open 22). There was no difference between robotic and open repairs in average defect width (4 cm primary, 9 cm incisional) or defect area (16,8 vs. 16,0 cm2 primary, 120 vs. 105 cm2 incisional). In primary hernias larger meshes were used in robotic procedures (291 vs. 197 cm2). In incisional hernias there was no difference (489 vs. 509 cm2). Median operation time for primary hernias was 114 vs. 99 minutes and hospital stay 1 vs.2 days after robotic vs. open procedure. In incisional hernia operation time was 205 vs. 184 minutes and hospital stay 2 vs. 3 days. After robotics complications (n = 9, 29%) were mild, mainly seromas. After open procedures (n = 10, 32%) complications were more severe leading to return to hospital (wound infections, mesh removal). Conclusion Robotic surgery should be offered to morbidly obese patients. More severe complications and prolonged hospital stay were seen after open procedures.