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Laparoscopic versus open ventral hernia repair in patients with chronic liver disease

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Abstract

Background

Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients.

Methods

Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors.

Results

A total of 3594 ventral hernia repairs were included, 536 (14.9 %) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95 % CI 0.07–0.74, p = 0.01), shorter length of stay (mean 3.7 vs. 5.0 days, p < 0.01) than OVHR, but similar systemic complications (p = 0.77), bleeding complications (p = 0.69), unplanned reoperation (p = 0.74) or readmission (p = 0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2 %) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95 % CI 1.00–28.60, p = 0.05), systemic complications (OR 7.03, 95 % CI 2.06–24.00, p < 0.01), and unplanned reoperation (OR 6.03, 95 % CI 1.51–24.12, p = 0.01) than OVHR.

Conclusions

In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.

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Authors and Affiliations

  1. Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA

    Yen-Yi Juo, Matthew Skancke, Jeremy Holzmacher, Richard L. Amdur, Paul P. Lin & Khashayar Vaziri

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  1. Yen-Yi Juo
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Correspondence to Yen-Yi Juo.

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Drs. Juo, Skancke, Holzmacher, Amdur, Lin, and Vaziri have no conflicts of interest or financial ties to disclose.

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Juo, YY., Skancke, M., Holzmacher, J. et al. Laparoscopic versus open ventral hernia repair in patients with chronic liver disease. Surg Endosc 31, 769–777 (2017). https://doi.org/10.1007/s00464-016-5031-6

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  • DOI: https://doi.org/10.1007/s00464-016-5031-6

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