Surgical endoscopy · 2026
Long-term outcomes of robotic intraperitoneal onlay mesh (IPOM) versus robotic enhanced-view totally extraperitoneal (eTEP) ventral hernia repair: a propensity-matched analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Carvalho Alvaro C, Schmidt Erika M, Bennett William C, Tocci Noah X, Huang Li-Ching, Miles Kimberly S, Tastaldi Luciano, Miller Benjamin T, Krpata David M, Prabhu Ajita S, Petro Clayton C, Beffa Lucas R
Аннотация
BACKGROUND: The robotic platform enables both intra- and extraperitoneal minimally invasive approaches to ventral hernia repair (VHR). Previous trials comparing intraperitoneal onlay mesh (IPOM) to enhanced-view totally extraperitoneal (eTEP) techniques have reported mainly short-term outcomes. We aim to report long-term outcomes comparing these approaches.
METHODS: The Abdominal Core Health Quality Collaborative (ACHQC) was queried for adults who underwent elective, clean VHR for defects ≤ 7 cm in width. Included patients had permanent synthetic mesh implanted and achieved fascial closure by either robotic IPOM (r-IPOM) or robotic eTEP (r-eTEP). Exclusion criteria included less than 3 years follow-up, presence of a stoma, or concomitant procedure(s) performed at time of VHR. Propensity score matching (PSM) based on pre-defined variables was used to compare quality of life, surgical site occurrences, readmissions, and reoperations between groups.
RESULTS: A total of 504 patients were identified. After PSM, 183 r-IPOM patients were matched to 183 r-eTEP patients. The r-IPOM group had smaller hernia width (3 cm vs. 5 cm; p < 0.001), implanted smaller mesh (12 × 15 cm vs. 17 × 25 cm; p < 0.001), lower drain use (1% vs. 15%; p < 0.001), fewer reoperations (n = 2 vs. n = 12), and no transversus abdominis myofascial releases (0% vs. 28%; p < 0.001). The r-IPOM arm had significantly shorter operative times (33% vs. 81% for ≥ 2 h; p < 0.001) and length of stay (0 vs. 1 days; p < 0.001). There were no differences in wound complications. There was no difference in clinical or radiographic recurrence rates; however, more patients reported bulging in the eTEP group at years 3 and 5. No significant difference was observed in hernia-specific quality-of-life scores.
CONCLUSIONS: Robotic eTEPs are associated with higher rates of patient-reported bulging and reoperation compared with r-IPOM without difference in clinical recurrence. The clinical significance of this is unclear and warrants further evaluation with more robust long-term follow-up.
METHODS: The Abdominal Core Health Quality Collaborative (ACHQC) was queried for adults who underwent elective, clean VHR for defects ≤ 7 cm in width. Included patients had permanent synthetic mesh implanted and achieved fascial closure by either robotic IPOM (r-IPOM) or robotic eTEP (r-eTEP). Exclusion criteria included less than 3 years follow-up, presence of a stoma, or concomitant procedure(s) performed at time of VHR. Propensity score matching (PSM) based on pre-defined variables was used to compare quality of life, surgical site occurrences, readmissions, and reoperations between groups.
RESULTS: A total of 504 patients were identified. After PSM, 183 r-IPOM patients were matched to 183 r-eTEP patients. The r-IPOM group had smaller hernia width (3 cm vs. 5 cm; p < 0.001), implanted smaller mesh (12 × 15 cm vs. 17 × 25 cm; p < 0.001), lower drain use (1% vs. 15%; p < 0.001), fewer reoperations (n = 2 vs. n = 12), and no transversus abdominis myofascial releases (0% vs. 28%; p < 0.001). The r-IPOM arm had significantly shorter operative times (33% vs. 81% for ≥ 2 h; p < 0.001) and length of stay (0 vs. 1 days; p < 0.001). There were no differences in wound complications. There was no difference in clinical or radiographic recurrence rates; however, more patients reported bulging in the eTEP group at years 3 and 5. No significant difference was observed in hernia-specific quality-of-life scores.
CONCLUSIONS: Robotic eTEPs are associated with higher rates of patient-reported bulging and reoperation compared with r-IPOM without difference in clinical recurrence. The clinical significance of this is unclear and warrants further evaluation with more robust long-term follow-up.