Network meta-analysis of robotic ventral and incisional hernia repair techniques: intraperitoneal, preperitoneal, retromuscular, and sublay approaches.

To compare the efficacy and safety of robotic ventral and incisional hernia repair techniques using network meta-analysis.

Robotic ventral hernia repair continues to evolve, but the comparative performance of individual robotic approaches remains uncertain.

We conducted a systematic review and network meta-analysis of 14 studies, including 2 randomized trials and 12 retrospective cohorts, involving 9,348 adults undergoing ventral or incisional hernia repair. Techniques were classified by mesh plane and operative access. Frequently reported approaches were analyzed as separate nodes, whereas less commonly described but conceptually similar techniques were grouped into pooled preperitoneal and retromuscular nodes. Treatment effects were estimated using a R (netmeta); heterogeneity, transitivity were assessed, and certainty was rated with CINeMA.

rIPOM and rTAPP ranked highest for operative efficiency (SUCRA 94% and 96%, respectively), whereas rTAR ranked lowest. Compared with rIPOM, overall complications were lower with rTEP-RM (RR 0.23, 95% CI 0.07-0.74) and rTAPP (RR 0.55, 95% CI 0.30-0.99). rTEP-RM was also associated with lower seroma rates (RR 0.28, 95% CI 0.10-0.80) and shorter length of stay (MD - 5.33 days, 95% CI - 9.08 to - 1.58), although postoperative pain was higher. Surgical site infection was lower with rRS (RR 0.11, 95% CI 0.02-0.87) and rTAPP (RR 0.32, 95% CI 0.13-0.78). Pooled preperitoneal approaches were associated with lower short-term recurrence and 30-day readmission.

Preperitoneal approaches, particularly rTEP-RM and rTAPP, were associated with more favorable early postoperative outcomes than rIPOM, although certainty of evidence was mostly low or very low.