Faculty Bibliography

Background: Inguinal hernia repair is one of the most common general surgery procedures with over 600,000 performed annually in the United States. When compared to traditional open inguinal hernia repair (OIHR), laparoscopic inguinal hernia repair (LIHR) has been associated with faster postoperative recovery rates and lower postoperative pain. With advances in the robotic platform, robotic inguinal hernia repair (RIHR) is an available technique that is currently being explored. This study examines LIHR and RIHR as described in literature to see if one is superior to the other. Study Design: Search terms: "Inguinal Hernia Repair" "Robotic Inguinal Hernia Repair," "Laparoscopic Inguinal Hernia Repair." A systematic search was performed in August 2017 of Medline, PubMed, and relevant journals using the above-listed search terms. Out of 80 articles found, only 8 were suitable for this content review. Results: Operative time in RIHR averaged 99 minutes as compared to 68 minutes in LIHR. Patients undergoing RIHR had an average complication rate of 5% with a recurrence rate of 0.06%. For obese patients, a lower percentage experienced postoperative complications when undergoing RIHR as compared to OIHR (unadjusted: 2.7% vs. 11.5%, p=0.005; and matched: 3.2 % vs. 10.8%, p=0.047), with bilateral robotic repairs more easily conducted in obese patients (unadjusted 29.7% vs. 16.8%, p=0.019; and unadjusted 35.1% vs. 11.5%, p\0.0001-respectively). More complicated procedures were performed using R-TAPP (n=11 vs. n=1, p=0.0001) with nearly identical (69.12 +/-35.13 min, R-TAPP; 69.05+/-26.31, L-TEP) intraoperative and postoperative complication rates. Similarly, average pain scores in recovery (2.5 vs 3.8, p=0.02) were significantly less after R-TAPP. However, mean operative time (77.5 vs 60.7 min, p=0.001) and room time (109.3 vs 93.0 min, p=0.001) were longer but with less recovery time and reported pain. Surgical complications including hematomas (3.9%), seromas (2.6%), and trocar site infection (1.3%) resolved with antibiotics, with a 2.6% postoperative complication rate. Conclusion: RIHR repair is a safe alternative to LIHR, with fewer postoperative complications and a faster recovery time. However, operative time as well as OR room time is significantly longer, which may increase overall cost. Further high quality randomized controlled trials are needed to assess efficacy and outcomes of RIHR

Introduction: Acute cholecystitis is a common surgical disease with roughly 500,000 cholecystectomies performed in the US annually. The current dogma revolves around the "72 hour rule" advocating early cholecystectomy if within the window, and if beyond 72 hours, conservative treatment and interval operation. In patients beyond the 72 hour window, as well as with multiple comorbidities, advanced age, and other complicating factors, cholecystostomy has become an acceptable treatment as a bridge to interval cholecystec-tomy. While this has become an appropriate treatment modality, it does not come without its own set of complications. We aim to evaluate the rate of complications in our institution. Methods: This is a retrospective review of all patients at our institution who underwent cholecystostomy placement between 2013 and 2016. We evaluate the comorbidities, readmission rate, overall rate of complication associated with cholecystostomy tubes, and eventual definitive cholecystectomy. Results: Our cohort includes 100 patients, 52% of whom were male, with a mean age of 71. We had an overall complication rate of 49.5%, including tube dislodgements, leaking tubes, and misplaced tubes. All cause readmission rate was 56% and only 32% of patients who had cholecystostomy drains underwent interval cholecystectomy. Conclusion: There has been much interest in treatment of acute cholecystitis in patients with multiple comorbidities. In review of our data, a surprisingly large number of patients had mechanical complications involving the cholecystostomy drain. In an era focused on decreasing readmission rates and their associated costs, drains carry a high risk of mal-function which will in turn, lead to increases in these two metrics. While there is more work to be done in the evaluation of early cholecystectomy versus cholecystostomy in this subgroup of patients, we suspect that early cholecystectomy in the medically optimized patient will lead to reduced length of stay and hospital costs as well as increased patient satisfaction