Modifiable comorbidities impact on ventral hernia recurrence following robotic abdominal wall reconstruction using resorbable biosynthetic mesh: 36-month follow-up

BACKGROUND: There is an ongoing debate on the role of comorbidities in hernia outcomes, particularly with minimally invasive approaches. This study evaluated the impact of modifiable comorbidities (MCMs) on 36-month hernia recurrence rates after robotic transversus abdominis release (TAR) with resorbable biosynthetic mesh underlay for primary ventral hernia repair. METHODS: A review of medical records for patients who underwent the robotic TAR procedure between January 2015 and May 2022 performed by a single surgeon was conducted. Patients were separated into three groups: those with 0, 1, and 2+ MCMs, followed by a breakdown of comorbidity types and combinations of comorbidities. MCMs included obesity, diabetes, and tobacco use. The primary outcomes included hernia recurrence at 36 months and the time between surgery and recurrence. RESULTS: 175 patients met the inclusion criteria, with a mean hernia diameter of 12.9 ± 5.4 cm and a mean BMI of 34 ± 8 kg/m(2). 9.7 % of patients experienced hernia recurrence at 36-month follow-up. No significant difference in the recurrence rate and length of time between surgery and recurrence was observed between the groups (p = .265 and p = .283, respectively). No group, single comorbidity, or a combination of comorbidities was found to have significantly increased odds of recurrence at 36 months. CONCLUSION: The presence of MCMs, either alone or in combination with another, did not significantly increase the odds of hernia recurrence at 36 months following ventral hernia repair using this approach. Future studies with larger sample sizes and multiple surgeons are needed to corroborate this data. KEY MESSAGE: Modifiable comorbidities have previously been shown to increase the risk of hernia recurrence after ventral hernia repair. Our study found relatively low rates of hernia recurrence and no significantly increased odds of recurrence among different comorbid groups at 36-month follow-up following robotic transversus abdominis release with resorbable biosynthetic mesh underlay.