Robotic Versus Open Incisional Ventral Hernia Repair with Sublay Mesh in Overweight Patients: A Case-Control Analysis of Clinical Outcomes and Costs

Abstract

Abstract Background Robotic incisional hernia repair (RIHR) with sublay mesh is gaining traction as a minimally-invasive alternative to open retro-rectus reconstruction (OIHR). Obesity is a known risk factor for complications following hernia repair. Aims The objective of this study is to compare the clinical outcomes and costs of RIHR versus OIHR with sublay mesh in overweight patients. Methods Patients with a body mass index (BMI) of 25-35 kg/m2 who underwent OIHR or RIHR with sublay mesh over a 2 years’ period were included. Recurrent hernias after mesh repair were excluded. The main outcome was length of hospital stay (LOS). Secondary outcomes included surgical site complications (SSC), visual analog pain score (VAS), analgesic methods, and general complications. Results Ninety patients were included, 45 in each group. The mean length of stay (LOS) was significantly shorter in RIHR (6.8 days ± 4.6 vs. 2.3 days ± 2, p < 0.001), as were VAS at day 0 (3.0 ± 2.7 vs. 1.7 ± 1.8, p = 0.005) and day 1 (4.2 ± 2.2 vs. 2.4 ± 1.8, p < 0.001), with a significant reduction in morphine consumption and epidural analgesia. The mean operative time was 163 min. ± 65 in OIHR and 191 min. ± 94 in RIHR (p = 0.06), despite a higher proportion of component separation in the robotic group (18% vs 33.3%, p = 0.005). The open group had higher rates of SSC (20% vs 2.2%, p = 0.015) and general complications (40% vs 13.3%, p = 0.004). General costs per diagnosis showed a mean reduction of 4797 CHF in the robotic group, mostly due to reduced hospitalization costs (9364 CHF vs. 3472 CHF). Conclusions The robotic approach improved post-operative outcomes of incisional hernia repair with sublay mesh compared to the open approach in overweight patients, without significantly increasing operative time and costs.