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A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs

  • J. M. McGreevy
  • P. P. Goodney
  • C. M. Birkmeyer
  • S. R. G. Finlayson
  • W. S. Laycock
  • J. D. Birkmeyer
Original article

Abstract

Background: Although ventral hernia repair is increasingly performed laparoscopically, complication rates with this procedure are not well characterized. For this reason, we performed a prospective study comparing early outcomes after laparoscopic and open ventral hernia repairs. Methods: We identified all the patients undergoing ventral (including incisional) hernia repair at a single tertiary care center between September 1, 1999 and July 1, 2001 (overall n = 257). To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, nonelective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. Postoperative complications (in-hospital or within 30-days) were assessed prospectively according to standardized definitions by trained nurse clinicians. Results: Of the 136 ventral hernia repairs that met the study criteria, 65 (48%) were laparoscopic repairs (including 3 conversions to open surgery) and 71 (52%) were open repairs. The patients in the laparoscopic group were more likely to have undergone a prior (failed) ventral hernia repair (40% vs 27%; p = 0.14), but other patient characteristics were similar between the two groups. Overall, fewer complications were experienced by patients undergoing laparoscopic repair (8% vs 21%; p = 0.03). The higher complication rate in the open ventral hernia repair group came from wound infections (8%) and postoperative ileus (4%), neither of which was observed in the patients who underwent laparoscopic repair. The laparoscopic group had longer operating room times (2.2 vs 1.7 h; p = 0.001), and there was a nonsignificant trend toward shorter hospital stays with laparoscopic repair (1.1 vs 1.5 days; p = 0.10). Conclusions: The patients undergoing laparoscopic repair had fewer postoperative complications than those receiving open repair. Wound infections and postoperative ileus accounted for the higher complication rates in the open ventral hernia repair group. Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair.

Keywords

Ventral hernia repair Laparoscopy Open repair 

References

  1. 1.
    Carbajo,  MA MdOJ, Blanco, JI, de la Cuesta, C, Toledano, M, Martin, F, Vaquero, C, Inglada, L 1999Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh.Surg Endosc13250225PubMedGoogle Scholar
  2. 2.
    Chari,  R CV, Eisenstat, M, Chung, R 2000A case controlled study of laparoscopic incisional hernia repair.Surg Endosc14117119Google Scholar
  3. 3.
    DeMaria,  EJ MJ, Sugerman, HJ 2000Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia.Surg Endosc14326329PubMedGoogle Scholar
  4. 4.
    Heniford,  BT RB 2002Laparoscopic ventral hernia repair.Surg Endosc14419423CrossRefGoogle Scholar
  5. 5.
    Holzman,  MD PC, Reintgen, K, Eubanks, S, Pappas, TN 1997Laparoscopic ventral and incisional hernioplasty.Surg Endosc113235PubMedGoogle Scholar
  6. 6.
    Khuri,  SF DJ, Henderson, W 1995The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.J Am Coll Surg180519531PubMedGoogle Scholar
  7. 7.
    Larson, . 2000Ventral hernia repair by the laparoscopic approach.Surg Clin North Am8013291340PubMedGoogle Scholar
  8. 8.
    Luijendijk,  RW HW, van den Tol, MP, de Lange, DC, Braaksma, MM, IJzermans, JN, Boelhouwer, RU, de Vries, BC, Salu, MK, Wereldsma, JC, Bruijninckx, CM, Jeekel, J 2000A comparison of suture repair with mesh repair for incisional hernia.N Engl J Med343392398PubMedGoogle Scholar
  9. 9.
    Park,  A BD, Lovrics, P 1998 Laparoscopic and open incisional hernia repair: a comparison study.Surgery124816821PubMedGoogle Scholar
  10. 10.
    Project, HcaU 1999Healthcare Statistics.Agency for Healthcare Research and QualityRockville, MDGoogle Scholar
  11. 11.
    Ramshaw,  BJ EP, Schwab, J,  et al. 1999Comparison of laparoscopic and open ventral herniorrhaphy.Am Surg65827831PubMedGoogle Scholar
  12. 12.
    Robbins,  SB PW, Gonzalez, RP 2001Laparoscopic ventral hernia repair reduces wound compications.Am Surg67896900PubMedGoogle Scholar
  13. 13.
    Toy,  FK BR, Carey, S, Chappuis, CW, Gagner, M, Josephs, LG, Mangiante, EC, Park, AE, Pomp, A, Smoot Jr, RT, Uddo Jr, JF, Voeller, GR 1997Prospective, multicenter study of laparoscopic ventral hernioplasty.Surg Endosc12955959CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • J. M. McGreevy
    • 1
  • P. P. Goodney
    • 1
    • 2
  • C. M. Birkmeyer
    • 1
  • S. R. G. Finlayson
    • 1
  • W. S. Laycock
    • 1
  • J. D. Birkmeyer
    • 1
    • 2
  1. 1.Department of SurgeryDartmouth-Hitchcock Medical Center, Lebanon, NHUSA
  2. 2.Department of Veterans Affairs Medical CenterVA Outcomes Group, White River Junction, VTUSA

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