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Background: This study aims to compare clinical outcomes and financial cost of intraperitoneal onlay mesh (IPOM) versus retromuscular (RM) repairs in robotic incisional hernia repairs (rIHR). Methods: Patients who underwent either IPOM or RM elective rIHR from 2012 to 2022 were included. Demographics, operative details, postoperative outcomes, and hospital costs were directly compared. Results: Sixty-nine IPOM and 55 RM were included. Age and body mass index (BMI) did not differ between both groups (IPOM vs RM: 59.3 ± 11.2 years vs. 57.5 ± 14 years, p= 0.423; BMI 34.1 ± 6.3 vs. BMI 33.2 ± 6.9, p= 0.435, respectively). Comorbidities and hernia characteristics were comparable. Extensive lysis of adhesions (> 30 min) was required more often in IPOM (18 vs. 6 in RM, p= 0.034). Defect closure was achieved in 100% of RM vs. 81.2% in IPOM (p< 0.001). Median (interquartile range) postoperative pain score was higher in RM than in IPOM [5(3–7) vs. 4(3–5), respectively, p= 0.006]. Median length of stay (0 day) and same-day discharge rate did not differ between groups (p= 0.598, p= 0.669, respectively). Six (8.7%) patients in the IPOM group versus one (1.8%) patient in the RM group were readmitted to hospital within 30 days postoperatively (p= 0.099). Perioperative complications were higher in IPOM (p= 0.011; 34.8% vs. 14.5% in RM) with higher Comprehensive Complication Index® morbidity scores [0(0–12.2) vs 0(0–0) in RM, p= 0.008)], Clavien–Dindo grade-II complications (8 vs 0 in RM, p= 0.009), and surgical site events (17 vs. 5 in RM, p= 0.024). Within a follow-up period of 57(± 28) months, recurrence rates were similar between both groups. Hospital costs did not differ between groups [IPOM: $9978 (7031–12,926) vs. RM: $8961(6701–11,222), p= 0.300]. Although postoperative complication costs were higher in IPOM ($2436 vs RM: $161, p= 0.020), total costs were comparable [IPOM: $12,415(8700–16,130) vs. RM: $9123(6789–11,457), p= 0.080]. Conclusion: Despite retromuscular repairs having lower postoperative complications than intraperitoneal onlay mesh repairs, both techniques offered encouraging results in robotic incisional hernia repair at a comparable total cost.

Background: The COVID-19 pandemic disrupted the healthcare sector and forced hospitals to limit the number of elective procedures with the goal of reducing overcrowding of wards and thus viral transmission. Recent trends for ventral hernia repair have shifted towards retromuscular techniques, which normally require a longer length of stay. Therefore, the aim of this study is to investigate the impact of the COVID-19 pandemic on clinical outcomes of robotic retromuscular ventral hernia repair (rRVHR). Methods: Patients who underwent rRVHR up to 600 days before and after March 10, 2020, were included in this retrospective study and assigned to the pre- or post-COVID group depending on the date of their procedure. Pre-, intra-, and postoperative variables including patients’ demographics, hernia characteristics, complications, and hernia recurrence were compared between both groups. Results: 153 (46% female) and 141 (51% female) patients were assigned to the pre- and post-COVID groups respectively. Median age was statistically different between both groups [pre-COVID: 57 (48–68) vs. post-COVID 55 (42–64) years, p= 0.045]. Median hospital length of stay (LOS) was 0 day (0–1) in both groups, and same day discharge were 61% pre-pandemic and 70% post-pandemic (p= 0.09). Mean postoperative follow-up was 39.2 (4.1–93.6) months. In total, 26 pre-COVID patients had postoperative complications, out of which 7 were pulmonary complications, whereas 23 complications were recorded in the post-COVID group, with only 3 pulmonary complications (p= 0.88). Rate of surgical-site events was comparable between both groups, and no recurrences were recorded. Conclusion: This is the first study to describe the impact of the COVID-19 on rRVHR. Hospital LOS was comparable between both groups. Rates of medical and hernia specific complications were not altered by the pandemic.

Background: Although the advantages of laparoscopic inguinal hernia repair (LIHR) have been described, guidelines regarding robotic inguinal hernia repair (RIHR) have yet to be established, despite its increased adoption as a minimally invasive alternative. This study compares the largest single-center cohorts of LIHR and RIHR and aims to shed light on the differences in outcomes between these two techniques. Methods: Patients who underwent LIHR or RIHR over an 8-year period were included as part of a retrospective analysis. Variables were stratified by preoperative, intraoperative, and postoperative timeframes. Complications were listed according to the Clavien–Dindo classification system and comprehensive complication index (CCI®). Study groups were compared using univariate analyses and Kaplan–Meier’s time-to-event analysis. Results: A total of 1153 patients were included: 606 patients underwent LIHR, while 547 underwent RIHR. Although demographics and comorbidities were mostly similar between the groups, the RIHR group included a higher proportion of complex hernias. Operative times were in favor of LIHR (42 vs. 53 min, p< 0.001), while RIHR had a smaller number of peritoneal breaches (0.4 vs. 3.8%, p< 0.001) as well as conversions (0.2 vs. 2.8%, p< 0.001). The number of patients lost-to-follow-up and the average follow-up times were similar (p= 0.821 and p= 0.304, respectively). Postoperatively, CCI® scores did not differ between the two groups (median = 0, p= 0.380), but Grade IIIB complications (1.2 vs. 3.3%, p= 0.025) and recurrences (0.8% vs. 2.9%, p= 0.013) were in favor of RIHR. Furthermore, estimated recurrence-free time was higher in the RIHR group [p= 0.032; 99.7 months (95% CI 98.8–100.5) vs. 97.6 months (95% CI 95.9–99.3). Conclusion: This study demonstrated that RIHR may confer advantages over LIHR in terms of addressing more complex repairs while simultaneously reducing conversion and recurrence rates, at the expense of prolonged operation times. Further large-scale prospective studies and trials are needed to validate these findings and better understand whether RIHR offers substantial clinical benefit compared with LIHR.