Robotic vs Laparoscopic vs Open Ventral Hernia Repair: Insights from a Network Meta-Analysis of Randomized Clinical Trials.

Abstract

Background: Ventral hernia repair is one of the most frequently performed surgical procedures worldwide, yet there is no consensus on the safest and most effective approach. This network meta-analysis aimed to evaluate the optimal surgical technique for ventral hernia repair.

Study design: We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing surgical interventions for ventral hernia repair. A frequentist network meta-analysis was conducted, pooling risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes with 95% confidence intervals (CIs).

Results: A total of 34 studies with 3,779 patients were included. No significant differences were observed in recurrence, seroma, or hematoma rates between groups. Laparoscopic IPOM plus significantly reduced hospital stays compared to open surgery (MD - 2.24 days; 95% CI -3.26 to -1.23) and wound infection risk (RR 0.29; 95% CI 0.21 to 0.41) compared to open surgery. The robotic approach was associated with increased operative time compared to both laparoscopic and open approaches (MD -49.08 minutes; 95% CI -87.77 to -10.39).

Conclusion: Laparoscopic and robotic techniques demonstrated similar efficacy regarding recurrence, seroma, and hematoma rates. While open surgery remains a more cost-effective approach, it was associated with a higher risk of wound infections. Given these findings, the choice of surgical technique should be individualized based on patient-specific factors, surgeon expertise, and institutional resources to optimize both clinical and economic outcomes.