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Background <p>Robotic-assisted ventral hernia repair has gained popularity for its enhanced precision and visualization. Two main approaches—r-IPOM and r-TAPP—differ in technique and risk profiles. r-IPOM/+ is technically simpler and preferred for larger defects, but may increase seroma and bowel-related complications. Conversely, r-TAPP employs extraperitoneal mesh positioning, potentially reducing postoperative complications. This meta-analysis aimed to compare perioperative outcomes between r-IPOM and r-TAPP, focusing on seroma, surgical site infection (SSI), and hernia defect closure. Secondary outcomes included recurrence, reoperation, operative time, and hospital stay.</p> Methods <p>A systematic meta-analysis, including 11 studies and 1001 patients, was performed. Pooled event rates and mean differences were calculated using random-effects models. Subgroup analyses based on mesh type and meta-regression assessing the impact of defect closure on complication rates were conducted. Evidence certainty was evaluated using the GRADE approach.</p> Results <p>Both approaches achieved high defect closure rates (r-IPOM+: 98%, r-TAPP: 99%; <i>p</i> = 0.9). Seroma and hematoma rates were low without significant differences; however, r-IPOM showed a slightly higher trend. r-TAPP demonstrated a significantly lower Surgical site infection (SSI) rate (1%) compared to (r-IPOM 4%, <i>p</i> = 0.02), although these complications themselves did not differ significantly between groups, indicating a possible but unconfirmed association. Recurrence, reoperation, operative time, and hospital stay were comparable. Meta-regression indicated a non-significant trend toward fewer complications with higher closure rates (<i>p</i> = 0.09). The GRADE assessment rated the certainty of evidence as high across all outcomes.</p> Conclusion <p>Both r-TAPP and r-IPOM are effective and safe for robotic ventral hernia repair. A significant inverse correlation between closure rates and complication rates underscores the importance of complete, tension-free closure. While perioperative outcomes are largely comparable, r-TAPP may reduce infection risk likely due to lower seroma and hematoma rates. Approach selection should be guided by patient factors, anatomical considerations, and surgical expertise.</p>

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“Comparative safety and efficacy of robotic TAPP and IPOM techniques in ventral hernia repair: a systematic review and meta-analysis of Short-term Outcomes”

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月19日

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  • Ahmed Abdelsamad,
  • Ibrahim Khalil,
  • Khaled Ashraf Mohamed,
  • Aya Sayed Ahmed Said Serour,
  • Mohammed Khaled Mohammed,
  • Noureldin Mostafa,
  • Youssef Osama Badie,
  • Zeyad M. Wesh,
  • Alaeldin Mohamedsami Mohamedosman Ali,
  • Florian Gebauer

摘要

Background

Robotic-assisted ventral hernia repair has gained popularity for its enhanced precision and visualization. Two main approaches—r-IPOM and r-TAPP—differ in technique and risk profiles. r-IPOM/+ is technically simpler and preferred for larger defects, but may increase seroma and bowel-related complications. Conversely, r-TAPP employs extraperitoneal mesh positioning, potentially reducing postoperative complications. This meta-analysis aimed to compare perioperative outcomes between r-IPOM and r-TAPP, focusing on seroma, surgical site infection (SSI), and hernia defect closure. Secondary outcomes included recurrence, reoperation, operative time, and hospital stay.

Methods

A systematic meta-analysis, including 11 studies and 1001 patients, was performed. Pooled event rates and mean differences were calculated using random-effects models. Subgroup analyses based on mesh type and meta-regression assessing the impact of defect closure on complication rates were conducted. Evidence certainty was evaluated using the GRADE approach.

Results

Both approaches achieved high defect closure rates (r-IPOM+: 98%, r-TAPP: 99%; p = 0.9). Seroma and hematoma rates were low without significant differences; however, r-IPOM showed a slightly higher trend. r-TAPP demonstrated a significantly lower Surgical site infection (SSI) rate (1%) compared to (r-IPOM 4%, p = 0.02), although these complications themselves did not differ significantly between groups, indicating a possible but unconfirmed association. Recurrence, reoperation, operative time, and hospital stay were comparable. Meta-regression indicated a non-significant trend toward fewer complications with higher closure rates (p = 0.09). The GRADE assessment rated the certainty of evidence as high across all outcomes.

Conclusion

Both r-TAPP and r-IPOM are effective and safe for robotic ventral hernia repair. A significant inverse correlation between closure rates and complication rates underscores the importance of complete, tension-free closure. While perioperative outcomes are largely comparable, r-TAPP may reduce infection risk likely due to lower seroma and hematoma rates. Approach selection should be guided by patient factors, anatomical considerations, and surgical expertise.