Long-term propensity-matched outcomes comparing laparoscopic with robotic ventral hernia repair with intraperitoneal mesh.

BACKGROUND

Recent evidence has challenged the long-term durability of robotic ventral hernia repairs. However, long-term outcomes between laparoscopic and robotic approaches for intraperitoneal mesh repairs (IPOM) remain limited, underscoring a critical need to evaluate outcomes over extended follow-up periods.

METHODS

We conducted a propensity-matched analysis of patients who underwent laparoscopic or robotic IPOM ventral hernia repair with permanent synthetic mesh. All patients completed a minimum 3-year follow-up in the Abdominal Core Health Quality Collaborative registry. The primary outcome was long-term hernia recurrence. Secondary outcomes included patient-reported pain, quality of life, and reoperations.

RESULTS

Following propensity score matching, 362 robotic IPOM and 362 laparoscopic patients were analyzed. Robotic IPOM patients experienced longer operative times (36 vs. 17% exceeding 2 h, P < 0.001) but more same-day discharges (63 vs. 53%, P = 0.02). Six-year risk of recurrence was 39.0% in the robotic group and 38.5% in the laparoscopic group, with no significant differences between approaches (P = 0.95). This finding persisted on multivariate analysis adjusting for residual baseline differences, fascial closure status and mesh fixation technique (HR 1.01; 95% CI 0.60-1.68; P = 0.973). Objective radiographic or clinical evaluation confirmed 14.3% of R-IPOM and 12.5% of L-IPOM recurrences, with patient-reported outcomes comprising the remainder. Despite identical pain scores (PROMIS 3A: 31 vs. 31, P = 1.00), robotic IPOM patients demonstrated statistically higher quality-of-life scores (HerQLes: 92 vs. 88, P = 0.03) at three years, though this 4-point difference does not exceed the minimal clinically important difference (MCID) of 15.6 points. No differences were observed in long-term wound morbidity or reoperation rates.

CONCLUSIONS

Robotic IPOM demonstrates equivalent long-term durability compared to laparoscopic approaches at a minimum 3-year follow-up. Robotic IPOM was associated with longer operative times but higher same-day discharge rates and marginally higher quality-of-life scores that do not meet clinically meaningful thresholds.