Multicenter observational study comparing robotic retrorectus and open preperitoneal mesh repair for treatment of primary ventral hernias.

Purpose: This study aimed to compare the long-term surgical outcomes of the open preperitoneal (PREPER) approach versus a robot-assisted Transabdominal Retromuscular Umbilical Prothesis (rTARUP) approach in primary ventral hernia repair.

Methods: Patients who underwent primary ventral hernia repair using either the PREPER or rTARUP technique were recruited. Data were collected on demographics, hernia, and mesh dimensions, as well as perioperative outcomes. Patients were contacted by telephone and assessed using the EuraHS-QoL and PINCH-Phone questionnaires to gather information on reoperations, recurrences, and patient reported outcomes. Clinical evaluations were conducted if recurrence was suspected.

Results: The analysis included 82 patients having a PREPER repair and 80 patients having a rTARUP repair, with on overall follow-up time of 6.2 and 5.1 years respectively. BMI was higher in the rTARUP group (p = 0.007), and hernia and mesh sizes were significantly larger in the rTARUP group (p < 0.0001). No significant differences in 30-day complications were observed (p = 0.77). Recurrence rates were 0.0% in the PREPER group and 2.5% in the rTARUP group (p = 0.24). EuraHS-QoL scores showed low levels of pain, restriction of activities, and esthetic discomfort in both groups.

Conclusion: The PREPER and rTARUP techniques demonstrate favorable long-term outcomes, with low recurrence rates and high quality of life. No clear advantage of one approach over the other was observed in the treatment of small-to medium sized midline hernias. Considering evidence indicating longer operative times and higher costs associated with the robotic platform, its use may provide limited added value in cases of low complexity with inherently low complication and recurrence rates.