Pilot Case Series of Robotic-Assisted Hernia Repair in Patients With Cirrhosis

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Abstract
Umbilical and ventral hernias in patients with cirrhosis cause significant morbidity including flood syndrome, bowel obstruction, and pain and limit quality of life. Ascites and portal hypertension increase the risk of complications, resulting in apprehension with intervention and costly cycles of readmission. No studies have explored the safety or efficacy of robotic-assisted repair of primary umbilical hernias in this population. We performed a retrospective review of patients with cirrhosis at a single institution who underwent elective or emergent robotic hernia repair between June 2023 and May 2024. A total of 7 patients were included with a median MELD-Na of 17 (IQR 14–22) and the majority of whom (6 of 7, 85.7%) had ascites at the time of surgery. Three patients required emergent or urgent operations. No drains were required at the time of surgery. There were no Clavien-Dindo grade 3 or higher complications, no patients had leakage of ascites from their incisions, and no patients developed hernia recurrence (median follow-up 173 days). There were 2 Clavien-Dindo grade 1 or 2 complications: one superficial skin infection treated with antibiotics and one case of urinary retention. This limited series suggests that robotic hernia repair is technically feasible and safe in a select group of patients with cirrhosis including those with ascites. We propose an approach to robotic-assisted hernia repair in these complex patients.

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