Reduced risk of recurrence following robotic-assisted TAPP for inguinal hernia repair compared to laparoscopic TAPP: a cohort study of 395 cases

Minimal invasive inguinal hernia repair is conducted using among others the laparoscopic transabdominal preperitoneal (TAPP) procedure or the extended totally extraperitoneal (eTEP) approach. Robotic-assisted TAPP (R-TAPP) has recently been introduced as an alternative to laparoscopic TAPP and TEP, and a growing number of robotic-assisted procedures are performed worldwide. The present study was conducted to determine the risk of chronic pain and recurrence associated with the two methods.

Three hundred ninety-five patients were retrospectively included in the study and underwent either laparoscopic TAPP (n = 177) or R-TAPP (n = 218). Data on patient demographics, hernia characteristics, and postoperative outcomes were retrieved from medical records. Kaplan-Meier curves and Cox proportional hazards regression were used to assess hernia recurrence. Logistic regression was used to analyze secondary outcomes such as inpatient status, hematoma, and chronic pain.

The Kaplan-Meier curves indicated a consistently higher cumulative incidence of recurrence in the TAPP group compared to the R-TAPP. Consistent with this finding, the Cox regression showed a higher risk of recurrence in patients undergoing TAPP, with a hazard ratio (HR) of 3.489 (95% CI: 1.232 to 9.880, p = 0.019). The E-value for this HR was 6.44, suggesting robustness to unmeasured confounding. There was no difference in the rates of chronic pain between the groups (OR: 1.233, 95% CI: 0.430 to 3.533, p = 0.696). A logistic regression analysis for other postoperative complications revealed no significant differences.

This study provides evidence that robotic-assisted TAPP is associated with a lower risk of recurrence than laparoscopic TAPP.