A Retrospective Study Comparing the Operative Outcomes of Extraperitoneal, Retrorectus Access Laparoscopic and Robotic‐Assisted Ventral Hernia Repairs

Abstract

BACKGROUND: This retrospective study aims to evaluate the operative outcomes of laparoscopic and robotic extraperitoneal repair of abdominal wall defects via enhanced view total extraperitoneal (eTEP) retrorectus space access. METHODS: A medical chart review was performed on consecutive eTEP cases from our unit, focused on collecting perioperative outcomes. RESULTS: One hundred and twenty cases were collected, 73 in the robotic group and 47 in the laparoscopic group. Approximately 38% of the robotic and 64% of the laparoscopic arms required component separation. In the overall population (irrespective of defect size and technique used), the robotic arm versus the laparoscopic arm had (a) significantly higher (P < 0.001) mean hernia defect, (b) shorter operating time (P < 0.001), (c) significantly fewer postoperative complications (P = 0.039), (d) significantly fewer pain scores at 24 hours and 14 days postsurgery (P = 0.002 and P < 0.001, respectively), and (e) better patient well-being scores (P = 0.001). The length of hospital stay and analgesic usage were comparable. A subgroup analysis by defect size (< 7 cm, 7-10 cm, and > 10 cm) revealed that approximately 51% of patients needed component separation in the laparoscopic group for defects < 7 cm, and 100% of patients needed it for hernias > 7 cm in this group. In the robotic group, no patient (0%) needed component separation for defects < 7 cm, and approximately 43% needed it for defects > 7 cm. CONCLUSIONS: This study reports encouraging short-term outcomes for the robotic-assisted eTEP approach in Indian settings. The robotic-assisted approach has the potential to reduce the requirement of component separation in patients with large ventral hernia defects. However, future prospective, randomized studies with long-term follow-up on recurrence will be needed to validate our findings.