Short-term outcomes after robot-assisted retromuscular versus laparoscopic intraperitoneal onlay mesh repair of small-to-medium ventral hernias: a prospective, multicenter, propensity score-matched analysis.

Purpose: To compare the short-term outcomes of robot-assisted retromuscular (R-RM) or laparoscopic intraperitoneal onlay mesh (L-IPOM) repair of small-to-medium ventral hernias.

Methods: All R-RM patients were prospectively enrolled, and their results collected in the French hernia registry. These were propensity score-matched (2:1) with L-IPOM patients whose results had already been prospectively collected in the registry. All patients had a primary or incisional hernia (M3 defect < 5 cm). The primary endpoint was the pain score on postoperative day 1 (POD1), using the 11-point numerical rating scale (NRS-11).

Results: The results from 69 consecutive R-RM patients were compared to 138 matched L-IPOM patients. At POD1, the NRS-11 score was 27% lower after R-RM (3.7) than L-IPOM (5.1; p = 0.0002). Operative times were longer for R-RM (96.4 vs. 34.4 min; p < 0.0001). A higher proportion of patients underwent day surgery with R-RM (76.8%) than L-IPOM (48.8%; p < 0.0001). One Clavien IIIb postoperative complication occurred after R-RM. The overall morbidity was comparable in both groups. The time to return to work was shorter after R-RM (p = 0.0302). One month after surgery, no recurrences had been reported; the risk of NRS-11 > 0 was more than double after L-IPOM (odds ratio 2.18 [95% confidence interval 0.97; 4.91]; p = 0.0606).

Conclusion: Despite a longer operative time, the R-RM approach was beneficial compared to L-IPOM in terms of postoperative pain, ambulatory rate, and time to return to work, with similar morbidity.