Robotic vs Open Retromuscular Abdominal Wall Hernia Repair

A hernia is a bulge through a hole in the muscles of the belly (abdomen) wall. A hernia at the front of the abdomen ('ventral' part) is called a ventral hernia. These happen in a weak area; either on its own or caused by an operation. These can cause pain, get in the way of things people want to do, be upsetting because of how they look, and sometimes can get stuck out (which can cause blockage of the bowels). These can make people's quality of life worse. Because of this, ventral hernias are often repaired in a planned way with an operation.

Expert groups have looked at the evidence from studies, and recommend that the best way to repair all but the smallest ventral hernias is by closing the weakness and reinforcing this and the area around it with an implant. This is called a mesh, and is normally made of plastic. Normally this mesh is placed directly behind the muscles, rather than on top of them. This is called a retromuscular ventral hernia repair.

This used to always be done through the skin over the hernia. This is called an open repair. More recently, it has become possible to do the same operation keyhole, using a surgical robot. This is called a robotic repair. Surgeons think that the end result is the same. But we do not know if how the operation is done affects patients' recovery and experience in the weeks and first few months after surgery.

The aim of this study is to see if people recover differently depending on whether their operation is done open or with a robot. To answer this question, we will run this study in a number of specialist hernia hospitals in the UK. We will ask people who have already decided to have this operation if they would like to take part. We are aiming for 132 people to sign up. They are free to say yes or no, and whatever they say we will not change what operation they have, when or where they have it, and which surgeon does it.

We will collect some information about their hernia and operation when they have surgery.

Then we will contact them in the weeks after their operation, to collect information about their recovery and quality of life. To compare people having robotic and open surgery, in our analysis we will use the information about them and their operation to 'match' them with the person who is most similar in the other group.

We will ask everyone if they want to take part in two extra parts of the study as well. Again, they are free to say yes or no to these as well. The first involves talking to people about their experiences of recovery, so we can understand these better. We can do this in person, on the phone or online depending on what suits them.

The second involves some people coming to our sports science laboratory in Exeter. In this laboratory we will use some simple tests to measure what they can do with their abdomen (such as movement). We see if people can perform these tests, and perhaps see if there is a difference between the operations.