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15.04.2020 | original article

Robotic repair of lateral incisional hernias using intraperitoneal onlay, preperitoneal, and retromuscular mesh placement: a comparison of mid-term results and surgical technique

European Surgery
MD, MBA, FACS Omar Yusef Kudsi, MD Naseem Bou-Ayash, MD Karen Chang, MD Fahri Gokcal
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Given the paucity of evidence surrounding lateral incisional hernias (LIH), optimal techniques remain elusive. We aim to compare perioperative and mid-term outcomes of patients who underwent robotic LIH repair using three techniques.


Patients were grouped as intraperitoneal onlay (IPOM), transabdominal preperitoneal (TAPP), or retromuscular (RM). Clavien–Dindo classification and Comprehensive Complication Index (CCI®; University of Zurich, Zurich, Switzerland) were used to report postoperative complications and morbidity scores. Surgical site events (SSEs), including surgical site occurrences (SSOs) and surgical site infections (SSIs), were also compared.


Of the 555 patients, 26 patients were included in the study; 5 (19.2%) underwent IPOM, 8 (30.8%) underwent TAPP, and 13 (50%) underwent RM repair. Although there were no differences regarding hernia defect size, a larger mesh size as well as a greater mesh overlap was achieved in the RM group compared to the IPOM and TAPP groups (p < 0.05). Additionally, RM repair allowed for a higher mesh-to-defect ratio than the recommended ratio of 16:1. There were no differences between groups in terms of postoperative outcomes, including SSEs, Clavien–Dindo grades, and CCI® scores.


No differences in mid-term outcomes between robotic IPOM, TAPP, or RM repair were noted. However, the robotic RM repair allows for significantly larger mesh size and mesh overlap, as well as a higher mesh-to-defect ratio.

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