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

Abstract

<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.