Natural History of Radiologic Incisional Hernia Following Robotic Nephrectomy

Ghoreifi, Alireza; Whang, Gilbert; Tran, Khoa; Tejura, Tapas; Liu, Benjamin; Cai, Jie; Lei, Xiaomeng; Cen, Steven; Aslzare, Mohammad; Burg, Madeleine L.; Desai, Mihir; Aron, Monish; Gill, Inderbir S.; Duddalwar, Vinay; Djaladat, Hooman

doi:10.1089/end.2020.0055

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…In contrast, clinically significant hernias can be found up to 11% of the time after transperitoneal robotic partial nephrectomies. 13 In our study, larger tumors (3.9 cm or greater) are a major risk for development of ILDH and this finding may imply that proper fascial closure should be done in such cases. However, fascial closure did not appear to be protective against ILDH when analyzed independently.…”

Section: Discussionmentioning

confidence: 50%

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Chow

Wahba

Phillips

et al. 2021

Journal of Endourology

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Introduction: Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. Methodology: This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020. Postoperative imaging was reviewed for evidence of ILDH. A clinically significant hernia was defined as the protrusion of visceral organ(s) through the lumbodorsal fascia. Patient and tumor characteristics, and fascial closure techniques were analyzed to determine predictors of ILDH. Results: In total, 150 patients underwent RRPN between 2007 and 2020 with an average follow-up of 4.9 (1-37) months. Twelve (8%) ILDHs were identified. Ten (6.7%) patients had herniated retroperitoneal fat whereas 2 (1.3%) patients had herniated colon. All were asymptomatic and managed conservatively. On matched cohort comparison, patients with ILDH had larger tumors than patients without an incisional hernia (3.9 cm vs 2.8 cm, p = 0.029). In general, patient factors were no different between patients with and without ILDH. However, coronary artery disease (CAD) was more prevalent in patients with ILDH (33.3% vs 10.9%, p = 0.028). Patients with ILDH were more likely to have a port site extended for specimen extraction (66.7% vs 38.2%, p = 0.069). Lumbodorsal fascial closure and type of suture material were not associated with prevention of ILDH ( p = 0.545, p = 0.637). Conclusion:The radiographic incidence of lumbar incisional hernias after RRPN without routine fascial closure of the extraction incision was 8%. All were asymptomatic and did not require surgical repair. Larger tumor size and CAD were associated with ILDH.

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Section: Discussionmentioning

confidence: 50%

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Chow

Wahba

Phillips

et al. 2021

Journal of Endourology

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Sarcopenia and body fat change as risk factors for radiologic incisional hernia following robotic nephrectomy

et al. 2023

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Objective To assess the effect of body muscle and fat metrics on the development of radiologic incisional hernia (IH) following robotic nephrectomy. Materials and Methods We retrospectively reviewed the records of patients who underwent robotic nephrectomy for kidney tumors between 2011 and 2017. All pre- and postoperative CTs were re-reviewed by experienced radiologists for detection of radiologic IH and calculation of the following metrics using Synapse 3D software: cross-sectional psoas muscle mass at the level of L3 and L4 as well as subcutaneous and visceral fat areas. Sarcopenia was defined as psoas muscle index below the lowest quartile. Cox proportional hazard model was constructed to examine the association between muscle and fat metrics and the risk of developing radiologic IH. Results A total of 236 patients with a median (IQR) age of 64 (54–70) years were included in this study. In a median (IQR) follow-up of 23 (14–38) months, 62 (26%) patients developed radiologic IH. On Cox proportional hazard model, we were unable to detect an association between sarcopenia and risk of IH development. In terms of subcutaneous fat change from pre-op, both lower and higher values were associated with IH development (HR (95% CI) 2.1 (1.2–3.4), p = 0.01 and 2.4 (1.4–4.1), p < 0.01 for < Q1 and ≥ Q3, respectively). Similar trend was found for visceral fat area changes from pre-op with a HR of 2.8 for < Q1 and 1.8 for ≥ Q3. Conclusion Both excessive body fat gain and loss are associated with development of radiologic IH in patients undergoing robotic nephrectomy.

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Natural History of Radiologic Incisional Hernia Following Robotic Nephrectomy

Cited by 2 publications

References 22 publications

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Sarcopenia and body fat change as risk factors for radiologic incisional hernia following robotic nephrectomy

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