Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Abstract

Few publications describe the potential benefit of robotic-assisted inguinal hernia repair on acute postoperative groin pain (APGP). This study compared patients’ perceptions of APGP, activity limitation, and overall satisfaction after robotic-assisted- (R), laparoscopic (L), or open (O) inguinal hernia repair (IHR). Random samples of patients from two web-based research panels and surgical practices were screened for patients who underwent IHR between October 28, 2015 and November 1, 2016. Qualified patients were surveyed to assess perceived APGP at 1 week postoperatively, activity disruption, and overall satisfaction. Three cohorts based on operative approach were compared after propensity matching. Propensity scoring resulted in 83 R-IHR matched to 83 L-IHR respondents, while 85 R-IHR matched with 85 O-IHR respondents. R-IHR respondents recalled less APGP compared to respondents who had O-IHR (4.1 ± 0.3 vs 5.6 ± 0.3, p < 0.01) but similar APGP compared to L-IHR (4.0 ± 0.3 vs 4.4 ± 0.3, p = 0.37). Respondents recalled less activity disruption 1 week postoperatively after R-IHR versus O-IHR (6.1 ± 0.3 vs. 7.3 ± 0.2, p < 0.01) but similar levels of activity disruption after R-IHR and L-IHR (6.0 ± 0.3 vs. 6.6 ± 0.27, p = 0.32). At the time of the survey, respondents perceived less physical activity disruption after R-IHR compared to O-IHR (1.4 ± 0.2 vs. 2.8 ± 0.4, p < 0.01) but similar between R-IHR and L-IHR (1.3 ± 0.2 vs 1.2 ± 0.2, p = 0.94). Most respondents felt satisfied with their outcome regardless of operative approach. Patient perceptions of pain and activity disruption differ by approach, suggesting a potential advantage of a minimally invasive technique over open for IHR. Further studies are warranted to determine long-term outcomes regarding pain and quality of life after IHR.

Laparoscopic totally extra‐peritoneal groin hernia repair with self‐gripping polyester mesh: a series of 780 repairs

“…Inguinal hernias have been repaired through a variety of approaches with growing evidence comparing open, laparoscopic transabdominal preperitoneal, and totally extra‐peritoneal (TEP) approaches . The introduction of robotic surgery provides another emerging minimally invasive approach . A Cochrane review in 2003 showed superior outcomes for postoperative pain, numbness, haematoma formation and surgical site infection for TEP and transabdominal preperitoneal repair over open surgery .…”

Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

“…A non-statistically-significant trend was also reported toward a faster return-to-work in the RIHR group compared to the LIHR and open IHR groups (18.2 vs. 21.1 vs. 23.6 days, respectively), in a subgroup of patients. 6 As discussed earlier, previous studies have shown prolonged operative time and higher cost, while also having an improved recovery time and postoperative pain in robotic compared to laparoscopic IHR. 5 – 8 , 13 , 14 No study, with a significant population size, analyzed whether such outcomes change with a surgeon’s growing RIHR experience across the learning curve.…”

“… 5 In a propensity-matched analysis, patients without a prior IHR reported a significantly reduced postoperative inguinal pain score at one week in RIHR compared to LIHR and open IHR (3.8 vs. 4.9 vs. 5.5, respectively). 6 In the same study, a subgroup of patients who underwent RIHR reported significantly shorter time to stopping the use of prescribed pain medication postoperatively compared to LIHR and open IHR (9 vs. 12.6 vs. 11.2 days, respectively). A non-statistically-significant trend was also reported toward a faster return-to-work in the RIHR group compared to the LIHR and open IHR groups (18.2 vs. 21.1 vs. 23.6 days, respectively), in a subgroup of patients.…”

“…Studies have reported improved postoperative pain, shorter use time of prescribed pain medication, lower post-anesthesia-care-unit (PACU) recovery time, and a trend toward sooner return to work compared to laparoscopic inguinal hernia repair (LIHR). 5 , 6 Such advantages to RIHR are offset by the prolonged intra-operative time and higher cost compared to the laparoscopic approach. 7 , 8 …”

Security and Radical Assessment in Open, Laparoscopic, Robotic Colorectal Cancer Surgery: A Comparative Study

“…With the development and popularization of minimally invasive techniques, laparoscopic techniques have been widely accepted due to the advantages of small trauma, rapid postoperative recovery and postoperative pain, and is gradually replacing traditional OS. 7 , 8 The robotic approach has been expected to be relevant to rectal cancer because the robotic interface is specifically suited for procedures in confined space, 9 while its safety and feasibility in the treatment of rectal cancer are uncertain. Our study aims to compare the 3 surgical approaches for rectal excision in a single institution.…”