Outcomes of open versus robotic preperitoneal ventral hernia repair: a propensity-matched analysis

Minimally invasive abdominal wall reconstruction has become increasingly accepted and performed in our complex population. Despite certain post-operative advantages, including possible decreased length-of-stay and wound complications, robotic ventral hernia repair (RVHR) remains controversial. The aim of this study was to evaluate outcomes, cost, and operative time following preperitoneal open (OVHR) versus RVHR.

Prospectively maintained data from a tertiary hernia center, including 1112 OVHR and 94 RVHR, was reviewed from 2016 to 2023. Patients were matched based on factors known to influence outcomes. A propensity-matched analysis was performed.

91 pairs were well-matched. Match criteria were not significantly different: BMI (30.7(25.3,35.2) vs. 31.4(27.6,34.8) kg/m²;p = 0.566), CDC wound class (85.7% vs. 90.1% clean;p = 0.363), ASA score (47.3% vs. 50.5% ASA-III; 51.6% vs. 46.2% ASA-II;p = 0.535), defect size (24(10,67) vs. 18 (9,40;p = 0.291), diabetes (23.1% vs. 23.1%;p > 0.999), smoking status (35.2% vs. 35.2% former smokers;p > 0.999), and primary vs. recurrent repair (80.1% vs. 80.1% primary; p > 0.999). Both groups had similar number of comorbidities (3(2,5) vs. 3(1,4);p = 0.095), operative time (110(80,182) vs. 106(85,176) minutes;p = 0.686), and wound complications (7.7% vs. 3.3%;p = 0.330). RVHR used smaller mesh (400(225,781) vs. 180(132,320) cm²;p < 0.001) and had shorter length-of-stay (3(2,5) vs. 1(0,2) days;p < 0.001). RVHR had higher operative ($12781(9674,16831) vs. $33756(28535,40468);p < 0.001) and total charges ($51015(35178,66603) vs. $66230(55872,81137);p < 0.001). There was no statistical difference in reoperations (0.0% vs. 1.1%;p > 0.999), recurrence (0.0% vs. 2.2%;p = 0.497), or follow-up (3.1(0.7,25.9) vs. 11.8(2.6,30.8);p = 0.050).

Preperitoneal OVHR and RVHR are comparable in terms of wound complications, reoperations, operative time, and hernia recurrence. While RVHR was associated with shorter length-of-stay, it resulted in higher charges.