Comparison of perioperative outcomes between non-obese and obese patients undergoing robotic inguinal hernia repair: a propensity score matching analysis

Purpose: Despite the limited research in support of robotic inguinal hernia repair (RIHR), it is an increasingly adopted technique in surgical practice. While a major risk factor for the development of ventral hernias and subsequent complications, obesity in RIHR has not been investigated. The aim of this study was to compare the outcomes of RIHR between obese and non-obese patients.

Methods: Prospectively collected data surrounding RIHRs performed at a single center between 2013 and 2020 were retrospectively reviewed. Patients were divided into non-obese (< 30 kg/m²) and obese (≥ 30 kg/m²) groups, and preoperative, intraoperative, and postoperative variables were compared in unmatched and matched groups, derived using a 1:2 propensity score match (PSM).

Results: From a total of 547 patients, 414 were non-obese and 133 were obese. A PSM analysis, accounting for confounding preoperative variables and risk factors, stratified these into 262 patients for the non-obese group and 131 patients for the obese group. Although the obese group's operative times were longer on average (57 min vs. 51 min; p = 0.007), this difference did not persist after matching. The only significant difference in operative variables was a higher rate of cord lipomas in the obese group. Postoperative variables, including wound complications, readmissions, and recurrence, were similar across unmatched and matched groups.

Conclusion: In the first study to investigate the influence of obesity in RIHR, no differences in outcomes were found between obese and non-obese patients. This procedure can be safely performed in obese individuals, however, more studies comparing body mass index (BMI) classes are needed to establish whether a prohibitive BMI threshold exists for RIHR.