Combined open-robotic 'sandwich' repair for flank hernias: a case series of 10 patients.

Background: Flank hernias represent a rare and technically challenging conundrum for abdominal wall surgeons. Various operative techniques have been attempted including open, laparoscopic, and robotic without an established gold standard. We present a novel technique utilizing a hybrid open-robotic "sandwich" technique for flank hernia repairs.

Methods: Single center, retrospective case series of a single surgeon performing consecutive flank hernia patients via novel technique between 2017 and 2023. Demographic information, clinical hernia characteristics, operative technique, peri-operative complications, and long-term outcomes were collected.

Findings: Ten patients underwent repair. Average age at repair was 67.6 (SD: 13.4), 70% males, mean BMI 29.6 (SD: 3.11), all ASA 3, and no current smokers. Average hernia defect measured 11.5 cm (SD: 8.3) vertically and 8.1 cm (SD: 3.7) horizontally. Mean operative time was 259.6 min (SD: 85.1), estimated blood loss 30.5 cc, and length of stay 1.6 days (SD 1.6). There were no intra-operative complications. 30-day morbidity included one (10%) patient developing an ileus and one (10%) patient had a hematoma. At a mean follow up of 34 months there was no chronic pain or hernia recurrences.

Conclusion: This study outlines a novel approach to complex flank hernia repairs utilizing a combination of an open and robotic approach. There were no long-term surgery related complications, chronic pain, or recurrences in our cohort with a minimum follow up of 6 months and mean of 34 months. Further studies need to be completed in prospective fashion to elucidate the goal standard repair for flank hernias.