Design: Nationwide survey linked to a hernia register
Population: 9,552 adults after elective mesh repair of primary ventral hernia under 10 cm
Primary outcome: Patient-reported pain, scar satisfaction and recurrence
Effect: Scar dissatisfaction 4.2% robotic, 5.7% laparoscopic vs 10.2% open; recurrence 11.4% laparoscopic vs 9.2% open

A Danish nationwide survey and register study in the Journal of the American College of Surgeons, published on 22 September, asked 9,552 adults (79% response) about long-term outcomes after elective mesh repair of a primary umbilical or epigastric hernia under 10 cm.

Severe chronic pain, foreign body sensation and physical impact did not differ between open, laparoscopic and robotic repair. Scar dissatisfaction was lower after laparoscopic (5.7%) and robotic (4.2%) repair than after open repair (10.2%). Patient-reported recurrence was slightly higher after laparoscopic than open repair (11.4% vs 9.2%).

For small primary hernias, approach can reasonably follow the patient's priorities. The recurrence measure is self-reported, which overestimates true recurrence, but the direction is worth mentioning when counselling about laparoscopic repair.

Ask patients what matters most — the scar, recovery or recurrence — before choosing an approach for a small primary hernia.
Tell patients that long-term chronic pain was similar whichever approach was used.
Mention the slightly higher self-reported recurrence after laparoscopic repair when consenting.
Note that these data cover elective mesh repairs of defects under 10 cm only.

Why it matters

It gives surgeons patient-reported numbers to use in consent, not just recurrence rates from operative series.

The statistics, in plain English

The scar dissatisfaction difference (−6.0 percentage points robotic vs open, 95% CI −8.2 to −3.8) is clear. The recurrence difference (2.2 points, CI 0.6 to 3.7) is real but small, and it is self-reported rather than confirmed on examination.