Long-Term Patient-Reported Outcomes after Robotic, Laparoscopic, and Open Primary Ventral Hernia Repair

Minimally invasive approaches are increasingly used for primary ventral hernia repair, but comparative patient-reported outcome evidence remains limited. We examined long-term patient-reported outcomes after robotic, laparoscopic, and open elective primary ventral hernia repair.

This nationwide survey- and register-based study included adults (≥18 years) undergoing elective mesh repair of primary (umbilical or epigastric) ventral hernias with defect widths <10 cm. Patient-reported outcomes were assessed using the Abdominal Hernia-Q capturing the prevalence of severe chronic pain, foreign body sensation, scar dissatisfaction, and patient-reported recurrence, as well as physical impact and appearance scores. Of 12,040 eligible patients, 9,552 responded (79%).

Severe chronic pain, foreign body sensation, and physical impact scores did not differ across approaches. Scar dissatisfaction was lower after laparoscopic repair than open repair (5.7% vs 10.2%; difference, -4.5%; 95% CI, -5.8 to -3.2; P <.001) and after robotic repair than open repair (4.2% vs 10.2%; difference, -6.0%; 95% CI, -8.2 to -3.8; P <.001). Patient-reported recurrence was higher after laparoscopic than open repair (11.4% vs 9.2%; difference, 2.2%; 95% CI, 0.6 to 3.7; P =.006). Appearance scores were slightly higher after laparoscopic than open repair (18.8 vs 18.5; mean difference, 0.3; 95% CI, 0.2 to 0.5; P <.001).

Long-term patient-reported outcomes were broadly comparable across approaches, but minimally invasive repair was associated with less scar dissatisfaction. Scar-related outcomes may inform approach selection when postoperative appearance is a patient priority.