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Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching

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Abstract

Background

The safety of emergent laparoscopic repair of incarcerated ventral hernias is not well established. The objective of this study was to determine if emergent laparoscopic repair of incarcerated ventral hernias is comparable to open repair with respect to short-term clinical outcomes.

Methods

Patients undergoing emergency repair of an incarcerated ventral hernia with associated obstruction and/or gangrene were identified using the ACS-NSQIP 2012–2016 dataset. One-to-one coarsened exact matching (CEM) was conducted between patients undergoing laparoscopic and open repair. Matched cohorts were compared with respect to morbidity, mortality, readmission, reoperation, missed enterotomies, and length of stay. Missed enterotomy was defined as any re-operative procedure within 30 days that required resection of large or small bowel segments, based on CPT codes. Multivariate analysis was conducted to determine adjusted predictors of morbidity.

Results

A total of 1642 patients were identified after CEM. Laparoscopic compared to open repair was associated with a lower rate of 30-day wound-morbidity (OR 0.35, 95% CI 0.22–0.57, p < 0.001). Laparoscopic repair was not associated with lower 30-day non-wound morbidity (OR 0.73, 95% CI 0.51–1.06, p = 0.094). Laparoscopic repair was associated with shorter LOS (3.6 days vs. 4.3 days, p = 0.014). A higher rate of missed enterotomies was observed in the laparoscopic cohort (0.7% vs. 0.0%, p = 0.031). There were no group differences with respect to 30-day readmission, reoperation, or mortality.

Conclusions

Emergency laparoscopic repair of incarcerated ventral hernias is associated with lower rates of wound-morbidity and shorter hospital stays compared to open repair. However, laparoscopic repair is associated with a higher rate of missed enterotomies; a rate which is low and comparable to elective non-incarcerated ventral hernia repairs.

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Acknowledgements

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Arash Azin, Dhruvin Hirpara, Timothy Jackson, Allan Okrainec, Ahmad Elnahas, Sami A. Chadi & Fayez A. Quereshy

  2. Division of General Surgery, University Health Network, Toronto, ON, Canada

    Timothy Jackson, Allan Okrainec, Ahmad Elnahas, Sami A. Chadi & Fayez A. Quereshy

  3. Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 8MP-320, Toronto, ON, M5T 2S8, Canada

    Fayez A. Quereshy

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  1. Arash Azin
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  2. Dhruvin Hirpara
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  3. Timothy Jackson
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  4. Allan Okrainec
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  5. Ahmad Elnahas
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  6. Sami A. Chadi
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  7. Fayez A. Quereshy
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Corresponding author

Correspondence to Fayez A. Quereshy.

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Disclosures

Arash Azin, Dhruvin Hirpara, Timothy Jackson, Allan Okrainec, Ahmad Elnahas, Sami A. Chadi, and Fayez A. Quereshy have no conflicts of interest or financial ties to disclose.

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Azin, A., Hirpara, D., Jackson, T. et al. Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc 33, 2812–2820 (2019). https://doi.org/10.1007/s00464-018-6573-6

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  • DOI: https://doi.org/10.1007/s00464-018-6573-6

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