Skip to main content
Log in

The utilization of laparoscopy in ventral hernia repair: an update of outcomes analysis using ACS-NSQIP data

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Numerous prospective studies and randomized controlled trials have demonstrated shorter length of stay, lower morbidity rates, and similar recurrence rates with laparoscopic ventral hernia repair (VHR) when compared to open VHR. Despite these promising results, previous data showed low utilization of laparoscopic VHR. The aim of our study was to evaluate the utilization of laparoscopic VHR using the most updated information from the American College of Surgeons—National Surgical Quality Improvement Project (NSQIP) dataset. The secondary aim was to evaluate the outcomes from NSQIP for patients undergoing open versus laparoscopic VHR for the outcome of 30-day mortality and the peri-operative morbidities listed in the NSQIP dataset.

Methods

We performed this study using 2009–2012 data from the ACS-NSQIP database. The study population included patients who had undergone an open or laparoscopic ventral hernia repair as their primary procedure based on CPT codes. Demographic characteristics, overall morbidity, and complications were compared using Chi-square tests for categorical variables and two-sided t tests for continuous variables. Secondary outcomes (mortality and any complications) were further analyzed using logistic regression.

Results

Utilization of laparoscopic VHR was 22 %. While adjusted mortality was similar, overall morbidity was increased in the open VHR group (OR 1.63; CI 95 % 1.38–1.92). The open group had a higher rate of return to the OR, pneumonia, re-intubation, ventilator requirement, renal failure/insufficiency, transfusion, DVT, sepsis, and superficial and deep incisional wound infections.

Conclusions

The utilization of laparoscopic VHR remained low from 2009 to 2012 and continued to lag behind the use of laparoscopy in other complex surgical procedures. The mortality rate between laparoscopic and open VHR was similar, but laparoscopic repair was associated with lower overall complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  2. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  CAS  PubMed  Google Scholar 

  3. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 discussion 399–400

    PubMed Central  PubMed  Google Scholar 

  4. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821 discussion 821–812

    Article  CAS  PubMed  Google Scholar 

  5. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780

    Article  CAS  PubMed  Google Scholar 

  6. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  CAS  PubMed  Google Scholar 

  7. Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  CAS  PubMed  Google Scholar 

  8. Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78:903–906

    Article  PubMed  Google Scholar 

  9. Asencio F, Aguilo J, Peiro S, Carbo J, Ferri R, Caro F, Ahmad M (2009) Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc 23:1441–1448

    Article  PubMed  Google Scholar 

  10. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145:322–328 discussion 328

    Article  PubMed  Google Scholar 

  11. Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D, Smedberg S, Osterberg J, Montgomery A (2013) Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg 258:37–45

    Article  PubMed  Google Scholar 

  12. Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386

    Article  PubMed  Google Scholar 

  13. Misiakos EP, Machairas A, Patapis P, Liakakos T (2008) Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair. JSLS 12:117–125

    PubMed Central  PubMed  Google Scholar 

  14. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858

    Article  CAS  PubMed  Google Scholar 

  15. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72

    Article  PubMed  Google Scholar 

  16. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:Cd007781

    PubMed  Google Scholar 

  17. Hwang CS, Wichterman KA, Alfrey EJ (2009) Laparoscopic ventral hernia repair is safer than open repair: analysis of the NSQIP data. J Surg Res 156:213–216

    Article  PubMed  Google Scholar 

  18. Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N (2011) Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database. Ann Surg 254:641–652

    Article  PubMed  Google Scholar 

  19. Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228:491–507

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Khuri SF (2005) The NSQIP: a new frontier in surgery. Surgery 138:837–843

    Article  PubMed  Google Scholar 

  21. Khuri SF, Henderson WG, Daley J, Jonasson O, Jones RS, Campbell DA Jr, Fink AS, Mentzer RM Jr, Steeger JE (2007) The patient safety in surgery study: background, study design, and patient populations. J Am Coll Surg 204:1089–1102

    Article  PubMed  Google Scholar 

  22. Ahad S, Gonczy C, Advani V, Markwell S, Hassan I (2013) True benefit or selection bias: an analysis of laparoscopic versus open splenectomy from the ACS-NSQIP. Surg Endosc 27:1865–1871

    Article  PubMed  Google Scholar 

  23. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP (2013) Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 184:216–220

    Article  PubMed  Google Scholar 

  24. Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson J, Oleynikov D (2012) Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 256:462–468

    Article  PubMed  Google Scholar 

Download references

Disclosures

Chetan V Aher, John C Kubasiak, Shaun C Daly, Imke Janssen, Daniel J Deziel, Keith W Millikan, Jonathan A Myers, and Minh B Luu have no financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chetan V. Aher.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aher, C.V., Kubasiak, J.C., Daly, S.C. et al. The utilization of laparoscopy in ventral hernia repair: an update of outcomes analysis using ACS-NSQIP data. Surg Endosc 29, 1099–1104 (2015). https://doi.org/10.1007/s00464-014-3798-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3798-x

Keywords

Navigation