A comparison of robotic mesh repair techniques for primary uncomplicated midline ventral hernias and analysis of risk factors associated with postoperative complications.

Purpose: We aim to compare short-term outcomes of robotic intraperitoneal onlay (rIPOM), transabdominal preperitoneal (rTAPP) and retromuscular (rRM) repair for uncomplicated midline primary ventral hernias (PVH) and determine risk factors associated with postoperative complications.

Methods: The three groups were compared in terms of pre-, intra-, and post-operative variables. Postoperative complications were assessed using previously validated classifications. Univariate analyses were conducted to determine which variables influence postoperative complications (up to 90 days), followed by a multivariate regression analysis revealing statistically important risk factors.

Results: A total of 269 patients who underwent robotic PVH repair patients were grouped as rIPOM (n = 90), rTAPP (n = 108), and rRM (n = 71). rRM repair allowed for the use of larger-sized meshes for larger defects; however, it was associated with higher-grade complications. rTAPP repair resulted in the lowest morbidity and offered the highest mesh-to-defect ratio for smaller-sized hernias. Operative time for the rRM group was longer. The rIPOM group had a higher morbidity, likely due to higher frequency of minor complications, as compared to rTAPP and rRM groups. Multivariate regression analysis revealed that coronary artery disease, absence of defect closure, intraperitoneally placed mesh, and skin-to-skin time (minutes) were significantly associated with postoperative complications.

Conclusion: Robotic PVHR contributes multiple techniques to a surgeon's armamentarium, such as IPOM, TAPP, and RM mesh placements. Patient characteristics as well as the potential consequences of each technique need to be taken into consideration when deciding the appropriate approach for the repair of primary uncomplicated midline ventral hernias.