Long-term outcomes of robotic intraperitoneal onlay mesh (IPOM) versus robotic enhanced-view totally extraperitoneal (eTEP) ventral hernia repair: a propensity-matched analysis.

Authors

Alvaro C Carvalho, Erika M Schmidt, William C Bennett, Noah X Tocci, Li-Ching Huang, Kimberly S Miles, Luciano Tastaldi, Benjamin T Miller, David M Krpata, Ajita S Prabhu, Clayton C Petro, Lucas R Beffa

Published in

Surgical endoscopy. Jul 10, 2026. Epub Jul 10, 2026.

Abstract

The robotic platform enables both intra- and extraperitoneal minimally invasive approaches to ventral hernia repair (VHR). Previous trials comparing intraperitoneal onlay mesh (IPOM) to enhanced-view totally extraperitoneal (eTEP) techniques have reported mainly short-term outcomes. We aim to report long-term outcomes comparing these approaches.
The Abdominal Core Health Quality Collaborative (ACHQC) was queried for adults who underwent elective, clean VHR for defects ≤ 7 cm in width. Included patients had permanent synthetic mesh implanted and achieved fascial closure by either robotic IPOM (r-IPOM) or robotic eTEP (r-eTEP). Exclusion criteria included less than 3 years follow-up, presence of a stoma, or concomitant procedure(s) performed at time of VHR. Propensity score matching (PSM) based on pre-defined variables was used to compare quality of life, surgical site occurrences, readmissions, and reoperations between groups.
A total of 504 patients were identified. After PSM, 183 r-IPOM patients were matched to 183 r-eTEP patients. The r-IPOM group had smaller hernia width (3 cm vs. 5 cm; p < 0.001), implanted smaller mesh (12 × 15 cm vs. 17 × 25 cm; p < 0.001), lower drain use (1% vs. 15%; p < 0.001), fewer reoperations (n = 2 vs. n = 12), and no transversus abdominis myofascial releases (0% vs. 28%; p < 0.001). The r-IPOM arm had significantly shorter operative times (33% vs. 81% for ≥ 2 h; p < 0.001) and length of stay (0 vs. 1 days; p < 0.001). There were no differences in wound complications. There was no difference in clinical or radiographic recurrence rates; however, more patients reported bulging in the eTEP group at years 3 and 5. No significant difference was observed in hernia-specific quality-of-life scores.
Robotic eTEPs are associated with higher rates of patient-reported bulging and reoperation compared with r-IPOM without difference in clinical recurrence. The clinical significance of this is unclear and warrants further evaluation with more robust long-term follow-up.

PMID:
42429785
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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