Design: Nationwide register-linked survey cohort
Population: 9,552 Danish adults after elective mesh repair of primary ventral hernia under 10 cm
Primary outcome: Patient-reported outcomes on Abdominal Hernia-Q
Effect: Scar dissatisfaction robotic 4.2% vs open 10.2% (difference -6.0%, 95% CI -8.2 to -3.8)

A Danish nationwide register and survey study included adults who had elective mesh repair of umbilical or epigastric hernias under 10 cm. Of 12,040 eligible patients, 9,552 (79%) completed a validated hernia questionnaire.

Severe chronic pain, foreign body sensation and physical impact did not differ between robotic, laparoscopic and open 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%).

The recurrence measure was self-reported rather than confirmed on examination or imaging, and approach was not randomised.

For small primary hernias, open mesh repair remains a sound default where cosmesis is not a priority. The choice can reasonably follow what the patient values, which should be asked.

Tell patients that long-term chronic pain was similar whichever approach was used.
Ask whether scar appearance matters to the patient before choosing the approach.
Mention that self-reported recurrence was slightly higher after laparoscopic repair.
Open mesh repair remains reasonable for small umbilical or epigastric hernias.

Why it matters

It removes chronic pain as a reason to prefer one approach and puts patient preference about scars into the decision.

The statistics, in plain English

A 79% response rate is high for a survey, which limits non-response bias. The recurrence difference of 2.2 percentage points has an interval of 0.6 to 3.7, so it is likely real but small, and it relies on what patients reported rather than examination.