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Surgical Endoscopy

, Volume 27, Issue 11, pp 4067–4072 | Cite as

Laparoscopic versus open repair of parastomal hernias: an ACS-NSQIP analysis of short-term outcomes

  • Wissam J. Halabi
  • Mehraneh D. Jafari
  • Joseph C. Carmichael
  • Vinh Q. Nguyen
  • Steven Mills
  • Michael Phelan
  • Michael J. Stamos
  • Alessio PigazziEmail author
Article

Abstract

Background

Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited.

Methods

The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis.

Results

Among the 2,167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p < 0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p < 0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p < 0.05), shorter length of hospital stay by 3.32 days (p < 0.001), lower risk of overall morbidity (OR = 0.42; p < 0.001), and a lower risk of surgical site infections (OR = 0.35; p < 0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29).

Conclusions

Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.

Keywords

Laparoscopy Parastomal Peristomal Hernia Colorectal Stoma Ostomy Short-term outcomes NSQIP 

Notes

Disclosures

The Department of Statistics at UC Irvine, with which V. Nguyen and M. Phelan are affiliated, was paid a statistical consulting fee by the Department of Surgery at UC Irvine. The Department of Surgery at UC Irvine, with which S. Mills is affiliated, was paid an educational grant from Ethicon. Ethicon, Covidien, Olympus, Adolor, and NiTi gave educational grants and speaker fees to the Department of Surgery at UC Irvine, with which M. Stamos is affiliated. Intuitive Surgical paid consultancy and educational grants to the Department of Surgery at UC Irvine, with which A. Pigazzi is affiliated.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Wissam J. Halabi
    • 1
  • Mehraneh D. Jafari
    • 1
  • Joseph C. Carmichael
    • 1
  • Vinh Q. Nguyen
    • 2
  • Steven Mills
    • 1
  • Michael Phelan
    • 2
  • Michael J. Stamos
    • 1
  • Alessio Pigazzi
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of California- IrvineOrangeUSA
  2. 2.Department of StatisticsUniversity of California IrvineIrvineUSA

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