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Robotic transabdominal preperitoneal versus laparoscopic intraperitoneal onlay mesh plus repair for small to medium
1Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. mabolafaraj@kau.edu.sa.
Abstract:
Laparoscopic intraperitoneal onlay mesh (IPOM +) repair is a standard approach for small-to-medium-sized abdominal wall hernias of ≤ 5 cm. However, robotic transabdominal preperitoneal (TAPP) repair offers potential advantages in precision and postoperative recovery. We aimed to evaluate short-term outcomes in a propensity-matched cohort with at least 1 year follow-up. This retrospective propensity-matched study included patients undergoing first-time repair for abdominal wall hernias of ≤ 5 cm. After exclusions, 114 eligible patients (73 laparoscopic IPOM + , 2016-2022; 41 robotic TAPP, 2020-2024) underwent 1:1 propensity score matching, yielding 41 matched pairs. The primary endpoint was postoperative pain, while the secondary endpoints were hospital length of stay (LOS), operative time, complications, and cost-effectiveness. The robotic TAPP group had longer operative times (75.2 vs. 58.6 min; p < 0.001), lower 24 h pain scores (visual analog scale, 2.4 vs. 5.8; p < 0.001), and shorter LOS (1.2 vs. 2.1 days; p = 0.002). Fewer analgesics were required in the TAPP group (mean morphine equivalent dose: 10.3 vs. 18.7 mg; p = 0.01). Complications within 1 year occurred in three patients with IPOM + (two prolonged ileus, one adhesive small bowel obstruction) and one patient with TAPP (port-site hernia; p = 0.61). Six TAPP cases converted to lateral Rives-Stoppa due to thin peritoneum. Costs were comparable between the two groups ($2486 vs. $2445; p = 0.78). For primary abdominal wall hernias of ≤ 5 cm where laparoscopic TAPP is technically infeasible, robotic TAPP repair demonstrates superior short-term outcomes and fewer complications with comparable costs.
Insights
Robotic transabdominal preperitoneal (TAPP) hernia repair shows better short-term results than laparoscopic intraperitoneal onlay mesh (IPOM+) repair for smaller hernias. Robotic TAPP offers less pain and shorter hospital stays with similar costs.
Area of Science:
- Minimally Invasive Surgery
- Abdominal Wall Reconstruction
- Surgical Technology
Background:
- Laparoscopic intraperitoneal onlay mesh (IPOM+) repair is standard for abdominal wall hernias up to 5 cm.
- Robotic transabdominal preperitoneal (TAPP) repair may offer enhanced precision and recovery.
Purpose of the Study:
- To compare short-term outcomes of robotic TAPP versus laparoscopic IPOM+ repair for abdominal wall hernias ≤ 5 cm.
- To evaluate postoperative pain, hospital stay, complications, and cost-effectiveness in a propensity-matched cohort.
Main Methods:
- Retrospective propensity-matched study of 114 patients (41 robotic TAPP, 73 laparoscopic IPOM+) undergoing first-time hernia repair.
- Propensity score matching created 41 matched pairs for analysis.
- Primary endpoint: postoperative pain; secondary endpoints: operative time, length of stay, complications, cost.
Main Results:
- Robotic TAPP had longer operative times (75.2 vs. 58.6 min) but significantly lower 24-hour pain scores (2.4 vs. 5.8) and shorter hospital stays (1.2 vs. 2.1 days).
- Fewer analgesics were needed in the TAPP group (10.3 vs. 18.7 mg morphine equivalent).
- One-year complication rates were similar (1/41 TAPP vs. 3/41 IPOM+), with comparable costs between groups.
Conclusions:
- Robotic TAPP repair demonstrates superior short-term outcomes for abdominal wall hernias ≤ 5 cm compared to laparoscopic IPOM+.
- The benefits include reduced postoperative pain and shorter hospital length of stay.
- Robotic TAPP is a viable, cost-effective alternative with comparable complication rates.
