"Comparative safety and efficacy of robotic TAPP and IPOM techniques in ventral hernia repair: a systematic review and meta-analysis of Short-term Outcomes".

Abstract

Background: Robotic-assisted ventral hernia repair has gained popularity for its enhanced precision and visualization. Two main approaches-r-IPOM and r-TAPP-differ in technique and risk profiles. r-IPOM/+ is technically simpler and preferred for larger defects, but may increase seroma and bowel-related complications. Conversely, r-TAPP employs extraperitoneal mesh positioning, potentially reducing postoperative complications. This meta-analysis aimed to compare perioperative outcomes between r-IPOM and r-TAPP, focusing on seroma, surgical site infection (SSI), and hernia defect closure. Secondary outcomes included recurrence, reoperation, operative time, and hospital stay.

Methods: A systematic meta-analysis, including 11 studies and 1001 patients, was performed. Pooled event rates and mean differences were calculated using random-effects models. Subgroup analyses based on mesh type and meta-regression assessing the impact of defect closure on complication rates were conducted. Evidence certainty was evaluated using the GRADE approach.

Results: Both approaches achieved high defect closure rates (r-IPOM+: 98%, r-TAPP: 99%; p = 0.9). Seroma and hematoma rates were low without significant differences; however, r-IPOM showed a slightly higher trend. r-TAPP demonstrated a significantly lower Surgical site infection (SSI) rate (1%) compared to (r-IPOM 4%, p = 0.02), although these complications themselves did not differ significantly between groups, indicating a possible but unconfirmed association. Recurrence, reoperation, operative time, and hospital stay were comparable. Meta-regression indicated a non-significant trend toward fewer complications with higher closure rates (p = 0.09). The GRADE assessment rated the certainty of evidence as high across all outcomes.

Conclusion: Both r-TAPP and r-IPOM are effective and safe for robotic ventral hernia repair. A significant inverse correlation between closure rates and complication rates underscores the importance of complete, tension-free closure. While perioperative outcomes are largely comparable, r-TAPP may reduce infection risk likely due to lower seroma and hematoma rates. Approach selection should be guided by patient factors, anatomical considerations, and surgical expertise.