Robotic parastomal hernia repair: an updated systematic review

INTRODUCTION: Parastomal hernias (PSH) are a frequent complication following ostomy surgery, often requiring surgical intervention. Robotic surgery offers potential advantages in PSH repair, but evidence on its efficacy remains limited. This systematic review evaluates the outcomes of different robotic PSH repair techniques. EVIDENCE ACQUISITION: A systematic search of PubMed, Embase, and Cochrane databases was conducted (2015-2024) to identify studies on robotic PSH repair. Fourteen studies (13 retrospective, two prospective) met the inclusion criteria after screening 324 articles. EVIDENCE SYNTHESIS: Data on patient demographics, surgical techniques, complications, recurrence rates, and follow-up duration were extracted. The analysis included 355 patients with a median follow-up of 12 months. Early studies focused on feasibility and safety, with subsequent research refining specific techniques like the Sugarbaker, Pauli, and keyhole repairs. Reported recurrence rates ranged from 0% to 9.5% across these techniques. However, 30-day complication rates varied significantly (0% to 50%), highlighting the need for standardized reporting and patient selection criteria. While some studies demonstrated low recurrence rates with acceptable complication profiles, others revealed higher complication rates, potentially related to specific techniques or patient factors. The emergence of variations within the Sugarbaker technique, such as the retromuscular approach with transversus abdominis release (TAR), demonstrates ongoing innovation in robotic PSH repair. CONCLUSIONS: Robotic PSH repair shows promise, but further research is needed to confirm its long-term efficacy and cost-effectiveness.