A Comparative Analysis between Laparoscopic and Open Ventral Hernia Repair at a Tertiary Care Center

Abstract

Laparoscopic ventral hernia repair reportedly yields lower postoperative complications than open repair. We hypothesized that patients undergoing laparoscopic repair would have lower postoperative infectious outcomes. Also, certain preoperative patient characteristics and preoperative hernia characteristics are hypothesized to increase complication risk in both groups. All ventral hernia repairs performed at University of Virginia from January 2004 to January 2006 were reviewed. Primary outcomes included wound healing complications and hernia recurrence. Categorical data were analyzed with χ2 and Fisher's exact tests. Continuous variables were evaluated with independent t tests and Mann-Whitney U tests. Multivariable logistic regression was performed. A total of 268 repairs (110 open, 158 laparoscopic) were evaluated. Patient and hernia characteristics were similar between groups, though the percents of wound contamination (5.4% vs 0.6%; P = 0.02) and simultaneous surgery (7.2% vs 0%; P = 0.001) were greater in the open procedures. Univariate analysis also revealed that open cases had a greater incidence of postoperative superficial surgical site infection (SSI) (30.0% vs 10.7%; P < 0.0001). Multivariable analysis revealed that both diabetes and open repair were associated with an increased risk of superficial SSI ( P = 0.019; odds ratio = 3.512; 95% confidence interval = 1.229–10.037 and P = 0.001; odds ratio = 4.6; 95% confidence interval = 1.9–11.2, respectively). Laparoscopic ventral hernia repair yielded lower rates of postoperative superficial SSI than open surgery. Other pre-operative patient characteristics and preoperative hernia characteristics, with the exception of diabetes, were not found to be associated with an increased risk of postoperative complications.

Robotic assistance in ventral hernia repair may decrease the incidence of hernia recurrence

“…Consistent with prior studies,[ 2 4 5 6 ] there was a significant decrease in surgical site infection rates when comparing laparoscopic to open VHR, as well as robotic, assisted to open VHR (OR lap vs. open 0.44 [0.29–0.66] and OR robot vs. open 0.30 [0.08–0.81]). However, there was no difference in surgical site infection rates when comparing laparoscopic and robotic-assisted VHR head-to-head (OR robot vs. lap 0.68 [0.19–1.80]).…”

“…Ventral hernia repair (VHR) is one of the most commonly performed general surgery procedures in the United States. [ 1 2 ] Since the first laparoscopic VHR in the early 1990s,[ 3 ] multiple studies have shown the advantages of laparoscopic over open VHR, particularly decreased hospital length of stay and lower instances of surgical site infections. [ 2 4 5 6 ] However, studies have also shown increased rates of serious complications with laparoscopic VHR such as enterotomy, especially in cases with significant lysis of adhesions.…”

“…[ 1 2 ] Since the first laparoscopic VHR in the early 1990s,[ 3 ] multiple studies have shown the advantages of laparoscopic over open VHR, particularly decreased hospital length of stay and lower instances of surgical site infections. [ 2 4 5 6 ] However, studies have also shown increased rates of serious complications with laparoscopic VHR such as enterotomy, especially in cases with significant lysis of adhesions. [ 7 8 ] Given conflicting data, it is understandable that laparoscopic VHR has not become the standard of care as laparoscopy has in other routine surgeries, such as cholecystectomy.…”

Female Gender and Diabetes Mellitus Increase the Risk of Recurrence after Laparoscopic Incisional Hernia Repair

“…DM patients carry a higher risk of SSI in open and laparoscopic hernia repairs. 11 Infection is a risk factor for the development of incisional hernia, so having DM should increase the risk of recurrence. However, in our series, DM patients who had a recurrence did not have documented evidence of infection.…”

Post-operative pain after laparoscopic ventral hernia repair, the impact of mesh soakage with bupivacaine solution versus normal saline solution: A randomised controlled trial (HAPPIEST Trial)

“…Laparoscopic approach to uncomplicated ventral hernia repair as compared to open repair has advantages of less post-operative pain, reduced risk of wound infection,[ 1 2 ] early recovery, short hospital stay and decreased overall cost of treatment. [ 3 4 5 ] Patient satisfaction after laparoscopic procedure is also better as compared to open repair.…”