Patient selection criteria for an effective laparoscopic intraperitoneal ventral hernia repair in day surgery
- 34 Downloads
The laparoscopic treatment of abdominal wall defects is currently a valid alternative to the open technique, given the possibility to significantly reduce the length of hospital stay and, consequently, to allow its carrying out in a day surgery setting. The comparison between the two methods has also been the subject of a Cochrane meta-analysis performed by Sauerland et al. (Cochrane Database Syst Rev 3: CD007781, 2011), which pointed out how, in spite of many clinical trials indicating the superiority of laparoscopy in terms of invasiveness and postoperative pain control, the quality of evidence is low due to the excessive variability among the different series in terms of reported complications. Moreover, what should be the selection criteria of patients fit for laparoscopic treatment in day surgery is not yet defined. This retrospective study considered 94 patients with primary or recurrent incisional wall hernias treated with laparoscopic technique over a 7-year period of time, from 2011 to 2018. The aim was to define the selection criteria for an effective day surgery laparoscopic treatment, considering as outcome the rate of conversion to ordinary hospitalization (discharge > POD1). Discharge > POD 1 was necessary in 15 cases out of 94 (16%). Concerning this outcome, statistically significant risk factors were ASA score > I (p = 0.022), number of hernia orifices > 1 (p = 0.001), recurrent hernias (p = 0.002) and hernia diameter > 10 cm (p < 0.0001). These factors were confirmed by univariate binary logistic analysis. A stepwise model of multivariate analysis showed as determinants for adverse events ASA score > 1 (OR 5.2, 95% CI 1.1–25.6, p = 0.043) and hernias > 10 cm (OR 7.0, 95% CI 1.1–46.4, p = 0.045). This work highlighted some useful criteria for preoperative selection of patients fit for laparoscopic abdominal wall defects repair in a day surgery setting. In particular, criteria related to a favorable clinical outcome were ASA score < II and a hernia diameter < 10 cm.
KeywordsAbdominal wall defects Laparoscopy Day surgery Selection criteria
Compliance with ethical standards
Conflict of interest
The author declares that they have no conflict of interest.
Research involving human participants and/or animals
The project has been submitted for the approval by Ethical Committee.
All the patients sign the informed consent.
- 1.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:CD007781Google Scholar
- 16.Perrone JM, Soper NJ, Eagon C et al (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. J Surg 130(4):708–716Google Scholar
- 19.Lorente-Herce JM, Marın-Morales J, Jimenez-Vega FJ, Ruiz-Julia ML, Claro-Alves BM, Fernandez-Zulueta A, Gallardo-Garcia PA, Marrero-Cantera S, De Quinta-Frutos R (2014) Laparoscopic incisional hernia repair in an ambulatory surgery-extended recovery centre: a review of 259 consecutive cases. Hernia 19(3):487–492 (Epub 2014 Mar 9) CrossRefGoogle Scholar
- 21.LeBlanc KAT, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41Google Scholar
- 23.Melman L, Jenkins ED, Deeken CR, Brodt MD, Brown SR, Brunt LM, Eagon JC, Frisella M, Matthews BD (2010) Evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic ventral hernia repair. Surg Innov. 17(4):285–290CrossRefGoogle Scholar
- 24.Olmi S, Erba L, Magnone S, Bertolini A, Mastropasqua E, Pereg P, Massimini D, Zanandrea G, Russo R, Croce E (2005) Prospective study of laparoscopic treatment of incisional hernia by means of the use of composite mesh: indications, complications, mesh fixation materials and results. Chir Ital. 57(6):709–716 (Italian. PubMed PMID: 16400765) Google Scholar
- 26.Sailes FC, Walls J, Guelig D, Mirzabeigi M, Long WD, Crawford A, Moore JH Jr, Copit SE, Tuma GA, Fox J (2010) Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg. 64(5):696–698 (PubMed PMID: 20395790) Google Scholar
- 28.Eriksen JR (2011) Pain and convalescence following laparoscopic ventral hernia repair. Dan Med Bull 58(12):B4369Google Scholar