Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias

The extended totally extraperitoneal (eTEP) repair has several theoretical advantages over the traditional intraperitoneal onlay mesh (IPOM) repair for ventral hernias, including the use of less expensive non-barrier coated mesh and avoiding complications of intraperitoneal mesh. However, one area in need of further investigation is cost and clinical comparisons following robotic eTEP with IPOM. A retrospective matched cohort study was conducted of patients with midline ventral hernias undergoing robotic eTEP or IPOM at a single academic institution from November 2019-August 2023. Patients were matched based on demographics, hernia defect size, and whether they underwent concomitant procedures. Primary outcomes included supply costs. Secondary outcomes included operative time, length of stay, complications, recurrence, and inpatient opioid utilization. In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m , and 54.5% were male. Hernia size was similar for both groups: 25 [6-73] cm for the IPOMs vs 40 [14-68] cm for eTEPs (p = 0.21). There was no significant difference in total supply costs between IPOMs and eTEPs: $2338 [2021-3249] vs $2082 [1619-3394] (p = 0.5) respectively. Mean operative time was significantly lower for IPOMs 159.6 ± 57.8 min vs 198.0 ± 67.1 (p = 0.006), while the average length of stay was significantly longer for IPOMs: 1.7 ± 1.2 days vs 1.2 ± 1.3 days (p = 0.021). Total inpatient MME utilized was greater for IPOM: 61 [36-102] vs 29 [10-64] MME (p = 0.003). Postoperative complications and recurrence rate were similar. There is no difference in total supply costs between patients undergoing robotic IPOM and eTEP repairs for midline ventral hernias. Though this study did find significant differences in total inpatient MME utilized and length of stay, it is debatable whether these are clinically significant. Further research is needed to determine appropriate indications for eTEP over IPOM.