Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
VA Long Beach Healthcare System, Long Beach, CA, USA.
Surg Endosc. 2022 Dec;36(12):9398-9402. doi: 10.1007/s00464-022-09259-x. Epub 2022 May 11.
BMI is a risk factor for recurrence and post-operative complications in both open and laparoscopic totally extraperitoneal approach (TEP) repair. Robotic surgery using the transabdominal preperitoneal approach (TAPP) is a safe and viable option for inguinal hernia repair (IHR). The objective of this study is to determine how difference in BMI influences rate of operative time, complications, and rate of recurrence in a robotic TAPP IHR.
We performed a retrospective review of patients who underwent robotic inguinal hernia repair between 2012 and 2019 at a Veterans Health Administration facility (N = 304). The operating time, outcomes, and overall morbidity and mortality for robotic IHR were compared between three different BMI Groups. These groups were divided into: "Underweight/Normal Weight" (BMI < 25) n = 102, "Pre-Obese" (BMI 25-29.9) n = 120, and "Obese" (BMI 30 +) n = 82.
The average operating time of a bilateral IHR by BMI group was 83.5, 98.4, and 97.8 min for BMIs < 25, 25-29.9, and 30 +, respectively. Operating time was lower in the Underweight/Normal BMI group compared to the Pre-Obese group (p = 0.006) as well as the Obese group (p = 0.001). For unilateral repair, the average operation length by group was 65.2, 70.9, and 85.6 min for BMIs < 25, 25-29.9, and 30 +, respectively, demonstrating an increased time for Obese compared to Underweight/Normal BMI (p = 0.001) and for Obese compared to Pre-Obese (p = 0.01). Demographic/comorbidity variables were not significantly different, except for a higher percentage of white patients in the Underweight/Normal BMI group compared to the Pre-Obese and Obese groups (p = 0.02 and p = 0.0003). There was no significant difference in complications or recurrence.
BMI has a significant impact on the operating time of both unilateral and bilateral robotic hernia repair. Despite this increased operative time, BMI group did not differ significantly in postoperative outcomes or in recurrence rates.
BMI 是开放式和腹腔镜完全腹膜外途径（TEP）修复术后复发和术后并发症的一个风险因素。使用经腹腔前腹膜途径（TAPP）的机器人手术是腹股沟疝修补术（IHR）的一种安全可行的选择。本研究的目的是确定 BMI 的差异如何影响机器人 TAPP IHR 的手术时间、并发症和复发率。
我们对 2012 年至 2019 年在退伍军人健康管理局设施接受机器人腹股沟疝修补术的患者进行了回顾性分析（N=304）。比较了三组不同 BMI 组的机器人 IHR 的手术时间、结果以及总体发病率和死亡率。这些组分为：“体重不足/正常体重”（BMI<25）n=102、“超重”（BMI 25-29.9）n=120 和“肥胖”（BMI 30+）n=82。
BMI 组双侧 IHR 的平均手术时间分别为 83.5、98.4 和 97.8 分钟，BMI 值分别为<25、25-29.9 和 30+。与超重组（p=0.006）和肥胖组（p=0.001）相比，体重不足/正常体重组的手术时间更短。对于单侧修复，各组的平均手术时间分别为 65.2、70.9 和 85.6 分钟，BMI 值分别为<25、25-29.9 和 30+，与体重不足/正常体重组相比，肥胖组的手术时间明显延长（p=0.001），与超重组相比，肥胖组的手术时间也明显延长（p=0.01）。除体重不足/正常体重组的白人患者比例明显高于超重组和肥胖组（p=0.02 和 p=0.0003）外，其他人口统计学/合并症变量无明显差异。
BMI 对单侧和双侧机器人疝修补术的手术时间有显著影响。尽管手术时间延长，但 BMI 组在术后结果或复发率方面无显著差异。
