Abstract
Background
Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative setting predictive of longer operative times and complexity in laparoscopic ventral hernia repair.
Methods
Patient demographics including body mass index (BMI), comorbidities, previous laparoscopic and open surgical procedures, ventral hernia repairs, and hernia characteristics (defect size and location, adhesions, incarceration) were recorded prospectively. Data are given as mean ± standard deviation. Times (min) required for abdominal access, adhesiolysis, and mesh placement as well as the total operative time were recorded during each case as outcome measures of operative difficulty. Univariate analyses were performed with the t-test or the Mann–Whitney U test as well as multivariate analyses using the stepwise analysis of covariance model to determine demographic and clinical variables influencing operative times.
Result
The study enrolled 180 patients (78 men and 102 women) with a mean age of 54.8 ± 12.2 years and a mean BMI of 33.3 ± 13.0 kg/m2. Multivariate analysis demonstrated significantly longer (p < 0.05) adhesiolysis and total operative times for patients with prior ventral hernia repairs, suprapubic hernia, bowel adhesion to the abdominal wall or hernia sac, and larger hernia defect. The total operative time also was increased (p < 0.05) with incarcerated hernia contents. Mesh placement time was increased (p < 0.05) with incarcerated hernia contents, suprapubic hernia location, hernias requiring larger mesh for repair, and decreased postgraduate year of the surgical assistant. The time required to obtain abdominal access was longer (p < 0.05) with a greater BMI and a higher American Society of Anesthesiology (ASA) classification. The operative times were not increased with a history of peritonitis, diabetes, immunosuppression, cancer, or with higher numbers of previous open or laparoscopic surgeries.
Conclusions
At least 10 preoperatively identifiable patient variables, either alone or in combination, are predictive of prolonged operative times during laparoscopic ventral hernia repair and may be used as surrogates to determine the complexity of a minimally invasive approach.
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Acknowledgment
We recognize the efforts of Eve Payne, CST, and Wayne Winkler, RN, who coordinated the operative time recordings.
Disclosures
Eric D. Jenkins, Lora Melman, Richard A. Pierce, Richard B. Schuessler, Victoria H. Yom, Margaret M. Frisella have no conflicts of interest or financial ties to disclose. J. Christopher Eagon has received consultant fees from Ethicon Endosurgery. L. Michael Brunt has received an honorarium for speaking and teaching, supplies for skills training, and grant support for clinical fellowship, and salary support from Ethicon Endosurgery; an honorarium for speaking and teaching and supplies for skills training from Covidien; grant support for education and training from both Stryker Endoscopy and Karl Storz Endoscopy; and grant support for research from Lifecell Corporation.. Brent D. Matthews has received consulting fees from Atrium Medical, Ethicon EndoSurgery, and the Muskuloskeletal Transplant Foundation, and an honorarium for speaking from W. L. Gore.
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Jenkins, E.D., Yom, V.H., Melman, L. et al. Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study. Surg Endosc 24, 1872–1877 (2010). https://doi.org/10.1007/s00464-009-0863-y
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DOI: https://doi.org/10.1007/s00464-009-0863-y