Risk, II.

Robotic-assisted abdominal wall repair (RAWR) has seen an exponential adoption over the last 5 years. Skepticism surrounding the safety, efficacy, and cost continues to limit a more widespread adoption of the platform. We describe our initial experience of 312 patients undergoing RAWR at a large academic center. A retrospective review of all patients undergoing any RAWR from July 1, 2016 to March 18, 2020 was completed. Patient specific, operation specific, and 30-day outcomes specific data were collected. Univariate analysis and multivariate logistic regression were used to assess factors associated with 30-day complications. There was a steady adoption of RAWR over the study period. A total of 312 patient were included, 138 (44%) were abdominal wall repairs and 174 (56%) were inguinal repairs. The mean age of the cohort was 54.2 years (SD 16), 69% were males, and the mean BMI was 29 kg/m 2 (SD 4.8). There were two reported intraoperative events and nine operative conversions. 60 patients had at least one complication at 30-days. These include: 52 seromas, 4 hematomas, 2 surgical-site infections, 1 deep venous thrombus, and 1 recurrence at 30-days. BMI, type of hernia, and sex were not associated with complications at 30-days. The use of absorbable mesh, longer hospital stay, operative conversion, previous repair, and expert hernia surgeon were significant predictors of 30-day complications. Age, operative conversion, and previous repair were the only predictors of 30-day complications on multivariate regression. Our initial experience of 312 patients demonstrates the adoption and comparable short-term outcomes for a wide variety of robotic-assisted hernia repairs.

Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM).Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018–March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP).Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1 day (0–12), and the median follow-up was 103 days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7 years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2 min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5 days (10–523), with two reported hernia recurrences.Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.

Background: Osteochondromas or Osteocartilaginous Exostosis are cartilage-capped bony growths arising from external bone surfaces. They typically occur at the level of growth plates and account for 30% of benign bone tumors. Vascular complications from osteochondromas are rare with roughly 112 reported cases in the literature dating back as early as 1953. Vascular injuries are location dependent, with popliteal pseudoaneurysms being the most prevalent. The operative techniques to repair these injuries have varied over time and are related to the location, degree of vascular injury, presence of thrombosis or infection and involvement of nearby structures like named veins or nerves. We present a case of a superficial femoral artery (SFA) injury secondary to an osteochondroma and offer a review of the literature evaluating the trends on operative repairs and their association with the degree of vascular injury. Methods: A total of 112 publications were found and independently reviewed. Articles containing age, sex, presentation, size of the aneurysm and surgical technique for repair were included for evaluation. Mean follow up, use of anticoagulation, and whether there was associated trauma was also recorded if reported by the authors. Articles with insufficient reported variables were excluded. A total of 49 publications were selected for evaluation based on these criteria. The review of literature was performed through PubMed, MEDLINE, NCBI using the words "pseudoaneurysm", "superficial femoral artery", "popliteal artery", and "osteochondroma". Results: Young Males were the most prevalent group (79.4%) with a mean age of 21.4 years of age. The most common complaint at presentation was pain and a palpable mass (81%) with no history of trauma (51%). Popliteal aneurysms (85%) were the most common vascular injury while the average size of injury was 5 mm. Operative techniques included arterioplasty (30.6%), end to end anastomosis (20.4%), greater saphenous vein (GSV) patch (20.4%) GSV bypass (8.1%) GSV interposition graft (8.1%) and xenopericardial or polytetrafluoroethylene (PTFE) patch (2%). Smaller arterial injuries (<5 mm) were most commonly managed with arterioplasty or end-to-end anastomosis. Conclusion: Vascular injuries secondary to osteochondromas are rare. High suspicion and prompt diagnosis are necessary to prevent long-term sequelae from neurovascular compromise. Smaller arterial defects appear to be best suitable for primary reconstruction either by arterioplasty or aneurysmectomy with end-to-end anastomosis. Ultimately, the surgical reconstruction needs to be guided in a case-by-case basis.

No abstract

No abstract

No abstract

No abstract