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 comparing surgical interventions for ventral hernia repair. A frequentist network meta-analysis was conducted, pooling risk ratios for binary outcomes and mean differences for continuous outcomes with 95% 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 intraperitoneal onlay mesh plus significantly reduced hospital stays compared with open surgery (mean difference -2.24 days; 95% CI -3.26 to -1.23) and wound infection risk (risk ratio 0.29; 95% CI 0.21 to 0.41) compared with open surgery. The robotic approach was associated with increased operative time compared with both laparoscopic and open approaches (mean difference -49.08 minutes; 95% CI -87.77 to -10.39). CONCLUSIONS: Laparoscopic and robotic techniques demonstrated similar efficacy in recurrence, seroma, and hematoma rates. Although 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.