Study Examines Long-Term Outcomes of Robotic, Laparoscopic, Open Ventral Hernia Repair

Fry BT, Howard RA, Thumma JR, et al. Surgical Approach and Long-Term Recurrence After Ventral Hernia Repair. JAMA Surg. 159, 1019-1028. 2024.

Sadaka AH, Itani KMF. Caution Warranted in Robotic Ventral Hernia Repair. JAMA Surg. 159, 1028-1029. 2024.

This study determined long-term outcomes (up to 10 years) of ventral hernia repairs performed with robotic techniques and compared the results with repairs performed with open or laparoscopic techniques.

Medicare claims data were gathered and analyzed retrospectively. The main outcome of interest was hernia recurrence. Instrumental variable statistical analysis was used to adjust for unmeasured patient factors such as hernia size. Cox proportional hazards modeling was used to account for factors such as patient age, comorbidities, and hernia subtype.

Records from 161,415 patients were included in the study. During the study interval, the rate of robotic repairs increased from 2.1% to 21.9%. The recurrence rate after robotic repairs was 13.36%. Recurrences occurred in 12.33 % of laparoscopic repairs and 12.74% of open repairs. These findings were consistent regardless of surgeon procedure volume.

The authors concluded that these findings support efforts to evaluate advantages and disadvantages of each operative approach to improve outcomes following ventral hernia repair.

In the editorial that accompanied the article, Sadaka noted that ventral hernia recurrence rates are frequently underreported. The findings reported by Fry and coauthors should prompt ongoing analysis of robotic repair outcomes so that benefits that justify the increased costs of robotic repairs can be documented.