Does (patient) size matter? the impact of body mass index on outcomes for patients undergoing minimally invasive transversus abdominis release.

BACKGROUND

Obesity increases the rate of postoperative wound complications for patients undergoing open abdominal wall reconstruction (AWR) and predisposes patients to hernia recurrence. While minimally invasive surgery (MIS) techniques minimize wound morbidity in obese patients, the exact degree to which this occurs remains unknown.

METHODS

A prospectively maintained single-institution hernia database was queried for patients undergoing robotic-assisted (rTAR) from 2018 to 2024. Basic demographics, operative characteristics and postoperative outcomes were reviewed. A univariate analysis was performed to compare outcomes for patients with a BMI < 35 kg/m2 (low BMI) to those with BMI ≥ 35 kg/m2 (high BMI). The primary outcomes were 30-day surgical site infection (SSI) and hernia recurrence.

RESULTS

There were 128 patients: 72 with low BMI and 56 with high BMI. Mean BMI for each group was 28.2±3.6 and 41.5±4.6 kg/m2, respectively (p < 0.01). There were more recurrent hernias (8.3% vs. 25.0%, p = 0.01) and larger hernia defects (median(Q1-3)) (101(35-192) vs. 150(98-240) cm2, p = 0.01) in the high BMI group. Most patients underwent bilateral TAR (69.4% vs. 73.2%, p = 0.70). There was no difference in SSI rate or (1.4% vs. 0.0%, p = 0.78) or hernia recurrence at 6 months (1.8% vs. 0.0%, p = 0.65). Quality of life outcomes were similar at 3 weeks and 6 months (each p > 0.05).

CONCLUSION

Despite having more complex hernias, the high and low BMI groups had comparable rates of 30-day SSI and short-term hernia recurrence. rTAR appears to be a safe and effective operation for patients with a BMI ≥ 35 kg/m2.