Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair

Area of Science:

• Abdominal Wall Reconstruction
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Transversus abdominis release (TAR) is a key technique for complex ventral hernias.
• Comparing open (oTAR) and robotic-assisted (rTAR) posterior component separation by TAR is crucial for optimizing patient care.

Purpose of the Study:

• To compare the clinical outcomes of open versus robotic-assisted transversus abdominis release for complex ventral hernias.
• To evaluate differences in postoperative hospital stay, complication rates, and recurrence between oTAR and rTAR.

Main Methods:

• A comparative study included consecutive patients undergoing bilateral TAR at two European hernia centers.
• The primary endpoint was the duration of postoperative hospital stay, with secondary endpoints including complication and recurrence rates.

Main Results:

• Robotic-assisted TAR (rTAR) demonstrated a significantly shorter postoperative hospital stay (3.4 days vs. 6.9 days) compared to open TAR (oTAR).
• The oTAR group experienced higher rates of short-term serious complications (20.3% vs. 7.8%) and surgical site infections (12.7% vs. 3.3%).
• Reoperation and recurrence rates were similar between rTAR and oTAR groups after a median follow-up of 19 and 43 months, respectively.

Conclusions:

• Bilateral rTAR offers significant advantages in reducing postoperative hospital stay and short-term complications for patients with ventral incisional hernias compared to bilateral oTAR.
• Both rTAR and oTAR achieve comparable long-term results regarding hernia recurrence and reoperation rates.