Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone
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- Orr, N.T., Davenport, D.L. & Roth, J.S. Surg Endosc (2013) 27: 67. doi:10.1007/s00464-012-2408-z
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Although incidental hernias frequently are found and repaired during laparoscopic cholecystectomy (LC), the outcomes of simultaneous LC and laparoscopic ventral hernia repair (LVHR) have not been scrutinized. In this study we evaluated short-term outcome data comparing simultaneous LC and LVHR against LC alone.
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005–2009) was queried using primary procedure and secondary current procedural terminology (CPT®) codes for LC and LVHR. Outcomes analyzed included separate LC and LVHR and simultaneous laparoscopic cholecystectomy and ventral hernia repair (LC/LVHR). The 30 day clinical outcomes along with postoperative hospital length of stay (LOS) were assessed using the χ2 test and analysis-of-variance test with p values < 0.01 set as significant. We also performed forward stepwise multivariable regression taking in to consideration over 50 ACS NSQIP risk factors to adjust for patient risk.
A total of 82,837 patients underwent LC and/or LVHR of which 357 (0.4 %) underwent simultaneous LC/LVHR. Patients who underwent LC/LVHR were more likely to have surgical site infections, suffer sepsis or septic shock, and have pulmonary complications, including pneumonia, reintubation or prolonged ventilator requirements, than LC-alone patients. No difference was noted in 30 day mortality, rates of deep vein thrombosis/pulmonary embolism (DVT/PE), renal insufficiency, or stroke. After multivariable adjustment for over 50 ACS NSQIP risk factors, concurrent LC/LVHR continued to pose a higher risk for these outcomes relative to LC only.
Simultaneous LC/LVHR results in greater postoperative morbidity in terms of surgical site infections, sepsis, and pulmonary complications when compared to LC alone. In light of this increased short-term morbidity, consideration should be given toward performing LC and LVHR independently in patients requiring both procedures. Prospective studies with long-term follow-up are required to better understand the implications of simultaneous LC/LVHR.