A comparison between robotic-assisted and open approaches for large ventral hernia repair—a multicenter analysis of 30 days outcomes using the ACHQC database

Introduction

Over the last few decades, there has been an increase in the use of a minimally invasive (MIS) approach for complex hernias involving component separation. A robotic platform provides better visualization and mobilization of tissues for component separation. We aim to assess the outcomes of open and robotic-assisted approaches for large VHR utilizing the ACHQC national database.

Methods

A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who had primary and incisional midline ventral hernias larger than 10 cm and underwent elective open and robotic hernia repairs with mesh from January 2013 to March 2023. Univariate and multivariate analyses were performed comparing Open and Robotic approaches.

Results

The ACHQC database identified 5,516 patients with midline hernias larger than 10 cm who underwent VHR. The open group (OG) had 4,978 patients, and the robotic group (RG) had 538. The RG had a higher median BMI (33.3 kg/m² (IQR 29.8–38.1) vs 32.7 (IQR 28.7–36.6) (p < 0.001). Median hernia width was 15 cm (IQR 12–18) in the OG and 12 cm in the RG (10–14) (p < 0.001). Sublay positioning of the mesh was the most common. The fascial closure was higher in the RG (524; 97% versus 4,708; 95%—p = 0.005). Median Length of Stay (LOS) was 5 days (IQR 4–7) in the OG and 2 days (IQR 1–3) in the RG (p < 0.001). The readmission rate was higher in the OG (n = 374; 7.5% vs n = 16; 3%; p < 0.001). 30-day SSI were higher in the OG (343; 6.9%% vs 14; 2.6%; p < 0.001). Logistic regression analysis identified diabetes (OR 1.6; CI 1.1–2.1; p = 0.006) and BMI (OR 1.04, CI 1.02–1.06; p < 0.001) as predictors of SSIs, while the robotic approach was protective (OR 0.35, CI 0.17–0.64; p = 0.002). For SSO, logistic regression showed BMI (OR 1.04, CI 1.03–1.06; p < 0.001) and smoking (OR 1.8, CI 1.3–2.4; p < 0.001) as predictors Robotic approach was associated with lower readmission rates (OR .04, CI 0.2–0.6; p < 0.001).

Conclusion

A robotic approach improves early 30-day outcomes compared to an open technique for large VHR. There was no difference in SSO at 30 days.