Diastasis plication during robotic transabdominal preperitoneal repair (rTAPP): a case series of outcomes at a tertiary care center.

Abstract

<h4>Background</h4>Despite increasing popularity, minimal data exist regarding diastasis plication during robotic ventral hernia repair for small defect sizes. We evaluated the safety and short-term efficacy of this procedure in a series of 30 patients at a tertiary care center using a single robotic technique.<h4>Methods</h4>We performed a single-institution retrospective study of adult patients who underwent elective robotic ventral hernia repair and concomitant diastasis plication with mesh between 10/1/2020 and 12/31/2022. Patients were identified from the electronic medical record and clinical and operative data were manually abstracted from patient charts.<h4>Results</h4>Thirty patients underwent robotic transabdominal preperitoneal repair and diastasis plication with mesh for hernia defects < 5 cm. Patient characteristics included mean age 50.6 ± 11.4 years, 50% female, BMI 32.5 ± 6.5 kg/m², 6.7% DMII, and 23.3% active smokers. Median operative time was 113.5 (IQR 97-147.5) minutes with 22% of patients undergoing a concurrent hernia repair (spigelian, inguinal, or multiple separate midline defects). Median hernia defect width was 3 ± 1.4 cm, median diastasis length was 10 ± 3.7 cm, and median mesh area was 64 ± 52.7 cm². No patients experienced surgical site infection, mesh infection, seroma, hematoma, or reoperation. Within 30 days, 3 patients were seen in the emergency department for superficial thrombophlebitis, reflux, and pain/emesis. There were no patients with clinical or radiographic recurrence at a mean postoperative follow-up of 116.0 ± 117.0 days.<h4>Conclusions</h4>Routine diastasis plication during robotic ventral hernia repair is safe and effective, with no increased rates of complications or adverse events and with no documented clinical or radiographic recurrence.