Short-term outcomes and risk factors for complications in robotic versus open parastomal hernia repair: a retrospective propensity score-matched analysis

Introduction: Parastomal hernias (PSHs) significantly impact the quality of life and pose risks including obstruction and stoma dysfunction. Minimally invasive approaches, particularly robotic surgery, are increasingly employed for elective PSH repairs, yet comparative outcomes remain insufficiently studied. This study evaluated short-term outcomes comparing robotic and open PSH repairs. Methods: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing elective open, laparoscopic, or robotic PSH repairs were identified. Propensity score matching was used to balance baseline characteristics, and multivariate logistic regression identified independent predictors of complications. Results: Of 1,322 patients, 734 (55.5%) underwent open repair, 408 (30.9%) robotic, and 180 (13.6%) laparoscopic. After matching 808 patients (404 robotic, 404 open), robotic repair significantly reduced overall complications (50 patients, 12.4% vs. 101 patients, 25.0%; p < 0.001), surgical complications (22 patients, 5.4% vs. 45 patients, 11.1%; p = 0.003), medical complications (36 patients, 8.9% vs. 66 patients, 16.3%; p = 0.001), superficial surgical site infections (8 patients, 2.0% vs. 26 patients, 6.4%; p = 0.002), and bleeding requiring transfusion (2 patients, 0.5% vs. 13 patients, 3.2%; p = 0.004). Robotic surgery also reduced length of stay (3.26 days vs. 6.08 days; p < 0.001). Multivariate analysis confirmed robotic technique as an independent protective factor against postoperative complications (OR: 0.414; p < 0.001). (OR: 0.414; p < 0.001). Conclusion: Robotic-assisted PSH repair significantly reduces perioperative morbidity, complication rates, and hospital length of stay compared to open surgery. These results support robotic approaches as preferable for elective PSH repair.