Robotic transabdominal preperitoneal versus laparoscopic intraperitoneal onlay mesh plus repair for small to medium primary ventral hernias: a propensity-matched cohort study.

Laparoscopic intraperitoneal onlay mesh (IPOM +) repair is a standard approach for small-to-medium-sized abdominal wall hernias of ≤ 5 cm. However, robotic transabdominal preperitoneal (TAPP) repair offers potential advantages in precision and postoperative recovery. We aimed to evaluate short-term outcomes in a propensity-matched cohort with at least 1 year follow-up. This retrospective propensity-matched study included patients undergoing first-time repair for abdominal wall hernias of ≤ 5 cm. After exclusions, 114 eligible patients (73 laparoscopic IPOM + , 2016-2022; 41 robotic TAPP, 2020-2024) underwent 1:1 propensity score matching, yielding 41 matched pairs. The primary endpoint was postoperative pain, while the secondary endpoints were hospital length of stay (LOS), operative time, complications, and cost-effectiveness. The robotic TAPP group had longer operative times (75.2 vs. 58.6 min; p < 0.001), lower 24 h pain scores (visual analog scale, 2.4 vs. 5.8; p < 0.001), and shorter LOS (1.2 vs. 2.1 days; p = 0.002). Fewer analgesics were required in the TAPP group (mean morphine equivalent dose: 10.3 vs. 18.7 mg; p = 0.01). Complications within 1 year occurred in three patients with IPOM + (two prolonged ileus, one adhesive small bowel obstruction) and one patient with TAPP (port-site hernia; p = 0.61). Six TAPP cases converted to lateral Rives-Stoppa due to thin peritoneum. Costs were comparable between the two groups ($2486 vs. $2445; p = 0.78). For primary abdominal wall hernias of ≤ 5 cm where laparoscopic TAPP is technically infeasible, robotic TAPP repair demonstrates superior short-term outcomes and fewer complications with comparable costs.