To evaluate the safety and short-term efficacy of robot-assisted surgery in the treatment of complex abdominal wall hernia.

This was a retrospective cohort study. A retrospective analysis was performed on the clinical data of 41 patients who underwent complex abdominal wall hernia repair at Tianjin Nankai Hospital between February 2023 and February 2025. According to different surgical approaches, patients were divided into the LH group (laparoscopic tension-free abdominal wall hernia repair, n=23) and the RH group (robot-assisted tension-free abdominal wall hernia repair, n=18). The perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, and diameter of abdominal wall defect), Visual Analogue Scale (VAS) pain scores at postoperative 3 days, 1 week, 1 month, and 3 months, as well as the incidence rate of postoperative complications including hernia recurrence, intestinal obstruction, intestinal fistula, wound infection, mesh infection, hematoma, and seroma were compared between the two groups. According to different hernia types, patients were divided into 5 subgroups: group A [giant abdominal wall hernia (maximum defect>10 cm)], group B (abdominal wall hernia with severe intra-abdominal adhesions), group C (recurrent/multiple hernias), group D (marginal hernia), and group E (incarcerated/strangulated hernia). Statistical analysis was further performed for subgroups with a case number of≥6.

There was no statistically significant difference in general data between the two groups (P>0.05). No significant differences were found in the perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, abdominal wall defect diameter) between the two groups (P>0.05). The VAS pain scores at 1 week and 1 month postoperatively in the RH group, as well as at all observed time points in subgroup D, were lower than those in the LH group, with statistically significant differences (P<0.05). The LH group was followed up for 6-24 months, and the RH group for 3-12 months. All patients completed the follow-up. During the follow-up period, the LH group had 2 cases of seroma, 1 case of hernia recurrence at 1 year postoperatively, and 1 case of chronic pain. The RH group had 1 case of seroma.The total complication rates were 17.4% (4/23) and 6% (1/18), respectively, with no statistically significant difference between the two groups (P=0.258).

Robotic- assisted and laparoscopic surgery have comparable safety in the treatment of complex abdominal wall hernia. Compared with conventional laparoscopic surgery, robotic-assisted technology offers advantages such as improved surgical precision and less postoperative pain in complex abdominal wall hernia repair, especially in pain control for marginal incisional hernias.