Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias
Introduction 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. Howeve...
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| Veröffentlicht in: | Surgical endoscopy 2025, Vol.39 (1), p.604-613 |
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| description | Introduction
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.
Methods
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.
Results
In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m
2
, and 54.5% were male. Hernia size was similar for both groups: 25 [6–73] cm
2
for the IPOMs vs 40 [14–68] cm
2
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.
Conclusion
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. |
| doi_str_mv | 10.1007/s00464-024-11319-3 |
| format | Article |
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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.
Methods
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.
Results
In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m
2
, and 54.5% were male. Hernia size was similar for both groups: 25 [6–73] cm
2
for the IPOMs vs 40 [14–68] cm
2
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.
Conclusion
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.</description><identifier>ISSN: 0930-2794</identifier><identifier>ISSN: 1432-2218</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-024-11319-3</identifier><identifier>PMID: 39467884</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2024 SAGES Oral ; Abdominal Surgery ; Aged ; Costs ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Hernia, Ventral - economics ; Hernia, Ventral - surgery ; Hernias ; Herniorrhaphy - economics ; Herniorrhaphy - methods ; Humans ; Laparoscopy - economics ; Laparoscopy - methods ; Length of stay ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Operative Time ; Postoperative Complications - etiology ; Proctology ; Retrospective Studies ; Robotic Surgical Procedures - economics ; Robotic Surgical Procedures - methods ; Robotics ; Surgery ; Surgical Mesh - economics ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2025, Vol.39 (1), p.604-613</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>Copyright Springer Nature B.V. Jan 2025</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-2c76ceb3725b42d4470ab4214bc4556296f328a459b53b6e22ce816478269e083</cites><orcidid>0000-0001-9486-9652</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-024-11319-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-024-11319-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39467884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saleh, Tariq</creatorcontrib><creatorcontrib>Kastenmeier, Andrew</creatorcontrib><creatorcontrib>Lak, Kathleen</creatorcontrib><creatorcontrib>Higgins, Rana</creatorcontrib><creatorcontrib>Goldblatt, Matthew</creatorcontrib><creatorcontrib>Tan, Wen Hui</creatorcontrib><title>Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
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.
Methods
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.
Results
In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m
2
, and 54.5% were male. Hernia size was similar for both groups: 25 [6–73] cm
2
for the IPOMs vs 40 [14–68] cm
2
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.
Conclusion
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.</description><subject>2024 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Costs</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Ventral - economics</subject><subject>Hernia, Ventral - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - economics</subject><subject>Herniorrhaphy - methods</subject><subject>Humans</subject><subject>Laparoscopy - economics</subject><subject>Laparoscopy - methods</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures - economics</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robotics</subject><subject>Surgery</subject><subject>Surgical Mesh - economics</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQhy0EotvCC3BAlrhsDyn-F8c-olVbKrVqD-UcOc6EdZXYwXaAfS5esF62gODAyZbnm9-M_CH0hpIzSkjzPhEipKgIExWlnOqKP0MrKjirGKPqOVoRzUnFGi2O0HFKD6TwmtYv0RHXQjZKiRX6sQnTbKLzn_Ecg4V-iWbENqScsPE9BhPHHbaj886WQliyDRMkHAYcQxeysxi-Z_A99DiHbMZCl4doZoguBw-laQ3353en-JvLW-z837XgR7PDJXGL11d3tzenOMJsXMRDiHhyfRkM-Cvsu0a8heidSa_Qi8GMCV4_nSfo08X5_eZjdX17ebX5cF1ZVstcMdtICx1vWN0J1gvREFMuVHRW1LVkWg6cKSNq3dW8k8CYBUWlaBSTGojiJ2h9yC0_82WBlNvJJQvjaDyEJbWcMlorLSUv6Lt_0IewRF-2K5RQsikSRKHYgbIxpBRhaOfoJhN3LSXtXml7UNoWpe1Ppe0--u1T9NJN0P9u-eWwAPwApHnvEeKf2f-JfQTR1q5O</recordid><startdate>2025</startdate><enddate>2025</enddate><creator>Saleh, Tariq</creator><creator>Kastenmeier, Andrew</creator><creator>Lak, Kathleen</creator><creator>Higgins, Rana</creator><creator>Goldblatt, Matthew</creator><creator>Tan, Wen Hui</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9486-9652</orcidid></search><sort><creationdate>2025</creationdate><title>Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias</title><author>Saleh, Tariq ; Kastenmeier, Andrew ; Lak, Kathleen ; Higgins, Rana ; Goldblatt, Matthew ; Tan, Wen Hui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-2c76ceb3725b42d4470ab4214bc4556296f328a459b53b6e22ce816478269e083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>2024 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Costs</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Ventral - economics</topic><topic>Hernia, Ventral - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - economics</topic><topic>Herniorrhaphy - methods</topic><topic>Humans</topic><topic>Laparoscopy - economics</topic><topic>Laparoscopy - methods</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures - economics</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Robotics</topic><topic>Surgery</topic><topic>Surgical Mesh - economics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saleh, Tariq</creatorcontrib><creatorcontrib>Kastenmeier, Andrew</creatorcontrib><creatorcontrib>Lak, Kathleen</creatorcontrib><creatorcontrib>Higgins, Rana</creatorcontrib><creatorcontrib>Goldblatt, Matthew</creatorcontrib><creatorcontrib>Tan, Wen Hui</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saleh, Tariq</au><au>Kastenmeier, Andrew</au><au>Lak, Kathleen</au><au>Higgins, Rana</au><au>Goldblatt, Matthew</au><au>Tan, Wen Hui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2025</date><risdate>2025</risdate><volume>39</volume><issue>1</issue><spage>604</spage><epage>613</epage><pages>604-613</pages><issn>0930-2794</issn><issn>1432-2218</issn><eissn>1432-2218</eissn><abstract>Introduction
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.
Methods
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.
Results
In total, 88 matched patients were included: 44 IPOM and 44 eTEP. Mean age was 57 years, BMI 35 kg/m
2
, and 54.5% were male. Hernia size was similar for both groups: 25 [6–73] cm
2
for the IPOMs vs 40 [14–68] cm
2
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.
Conclusion
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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>39467884</pmid><doi>10.1007/s00464-024-11319-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9486-9652</orcidid></addata></record> |
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| subjects | 2024 SAGES Oral Abdominal Surgery Aged Costs Female Gastroenterology Gynecology Hepatology Hernia, Ventral - economics Hernia, Ventral - surgery Hernias Herniorrhaphy - economics Herniorrhaphy - methods Humans Laparoscopy - economics Laparoscopy - methods Length of stay Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Middle Aged Operative Time Postoperative Complications - etiology Proctology Retrospective Studies Robotic Surgical Procedures - economics Robotic Surgical Procedures - methods Robotics Surgery Surgical Mesh - economics Treatment Outcome |
| title | Comparing procedural costs and early clinical outcomes of robotic extended totally extraperitoneal (eTEP) with intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias |
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