Robotic versus open mesh-enforced retrorectus ventral hernia repair: a multi-center comparative study

Abstract Mesh-enforced open ventral hernia repair (OVHR) is associated with increased surgical site occurrences and prolonged hospital stay. Robotic-assisted ventral hernia repair (RVHR) may offer benefits compared to OVHR, but comparative literature is scarce. This multicenter prospective cohort study used data from the international CROSSFIRE (MultiCentre InteRnational PrOSpective DatabaSe For Ventral HernIa REpair) register. Patients undergoing OVHR or RVHR for ventral hernias with 3–15 cm transverse diameter between December 2023 and March 2026 were analyzed. The primary outcome was surgical revision after 30 days. Secondary outcomes included postoperative pain after 2 days and 6 weeks, operative time, length of stay (LOS), readmissions and follow-up at 1 year. Two hundred thirty patients were included and analyzed, of which 77 (41% female, BMI 28.4 kg/m2, 90.7% incisional hernias, median hernia diameter 4 cm) underwent OVHR, and 153 (33.7% female, BMI 29.4 kg/m2, 91.7% incisional hernias, median hernia diameter 5 cm) underwent RVHR. Surgical revisions were more frequent after OVHR compared to RVHR (13.7% vs. 4.8%; p = 0.027). Median LOS was longer after OVHR (4 days vs. 3days; p < 0.001). Median operation time was shorter in OVHR (100 min vs. 210 min; p < 0.001). The pain after two days was lower after OVHR (VAS 2 vs. 3; p = 0.002); however, it was higher after 6 weeks (2 vs. 1 VAS; p = 0.008). After one year, the clinical recurrence rate was higher after OVHR 7.1% vs. 0.0%; p = 0.010). RVHR was associated with fewer surgical revisions after 30 days, a shorter LOS, less pain after 6 weeks and improved outcomes after one year. Randomized controlled trials are needed to confirm these findings.