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

Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.