Laparoscopic Intraperitoneal Onlay Mesh Versus Robotic Retromuscular for Small- and Medium-Sized Ventral Hernia Repair: A Systematic Review and Meta-Analysis

Introduction: This study aims to perform a systematic review and meta-analysis to compare the laparoscopic intraperitoneal onlay mesh (IPOM) versus the robotic retromuscular (RM) techniques and their respective outcomes for small and medium-sized ventral hernia repair. Methods: A comprehensive online search was conducted using PubMed, Cochrane, and Embase. Studies comparing laparoscopic IPOM to robotic RM techniques were included. The results analyzed were the length of stay (LOS), surgical site infection (SSI), surgical site occurrence (SSO), readmission, and reoperation. Statistical analysis was performed with R Studio version 4.4.1 using a random-effects model. Results: From 956 records, three retrospective observational studies were included, encompassing 1351 patients (laparoscopic IPOM n = 882; robotic RM n = 469). Primary hernias represented 63%, and 88% had horizontal defects between 3.1 and 3.4 cm. Overall analysis showed comparable results between groups regarding LOS (mean difference: 0.58; 95% confidence interval [CI]: -0.07 to 1.24; P = .08), SSI (risk ratio (RR): 0.90; 95% CI: 0.28-2.85; P = .85), and SSO rates (RR: 1.07; 95% CI: 0.17-6.55; P = .94). In addition, no statistically significant results were seen for readmission (RR: 1.50; 95% CI: 0.79-2.85; P = .21) and reoperation rates (RR: 1.16; 95% CI: 0.47 to 2.86; P = .74). Conclusion: This meta-analysis found similar postoperative outcomes for both laparoscopic IPOM and robotic RM techniques. Future studies are still required to evaluate the role of these operative methods following small- and medium-sized VHR.