Association for Academic Surgery Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications Sergio Huerta, MD, FACS, a,b, * Corey Timmerman, BS, a Madison Argo, BS, a Juan Favela, BA, a Thai Pham, MD, FACS, a,b Sachin Kukreja, MD, FACS, b Jingsheng Yan, PhD, c and Hong Zhu, PhD c a Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas b Department of Surgery, VA North Texas Health Care System, Dallas, Texas c Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas article info Article history: Received 8 December 2018 Received in revised form 20 February 2019 Accepted 22 March 2019 Available online xxx Keywords: Inguinodynia Bassini repair McVay repair Shouldice repair Hernia recurrence abstract Background: The robotic approach to an inguinal hernia has not been compared head to head with the open and laparoscopic techniques in randomized controlled trials. Furthermore, long-term outcomes for robotic inguinal hernia repair (RHR) are lacking. In this study, we compared laparoscopic inguinal hernia repair (LHR) and RHR with open inguinal hernia repair (OHR) in veteran patients performed by surgeons most familiar with each approach. Methods: A retrospective single-institution analysis of 1299 inguinal hernia repairs per- formed at the VA North Texas Health Care System between 2005 and 2017 was under- taken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed. Univariable analysis was undertaken to determine associations between techniques and outcomes (OHR versus LHR; OHR versus RHR; LHR versus RHR). Setting complications as a dependent variable, multivariable analyses were undertaken to determine an association with complications as well as independent predictors of complications. Results: Patient demographics were similar among groups except for age that was higher in the OHR cohort. The average follow-up was 5.2  3.4 y. In the present report, recurrence was associated with a higher rate in the RHR versus OHR (5.6% versus 1.7%; P < 0.02), but not in the LHR versus OHR (3.9% versus 1.9%; P ¼ 0.09). Inguinodynia was more likely to occur in both the LHR and RHR compared with the OHR (9.4% and 14.1 versus 1.5%; both P’s < 0.001). Urinary retention was also more common in the LHR and RHR than in the OHR (5.5% and 5.6% versus 1.8%, both P’s < 0.05) as was the rate of overall complications (34.4% and 38.0% versus 11.2%, both P’s < 0.001). Multivariable regression analysis showed femoral hernias, ASA, serum albumin, operative room This article is an extension of an abstract presented at the 14th Annual Academic Surgical Congress, Houston in February 5-7, 2018. * Corresponding author. University of Texas Southwestern, Medical Center, VA North Texas Health Care System, 4500 S. Lancaster Road (112), Surgical Service, Dallas, TX. Tel.: (214) 857-1800; fax: (214) 648-6700. E-mail address: Sergio.Huerta@UTSouthwestern.edu (S. Huerta). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  september 2019 (241) 119 e127 0022-4804/$ e see front matter Published by Elsevier Inc. https://doi.org/10.1016/j.jss.2019.03.046