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Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis

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Abstract

Introduction

The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures. The aim of this study was to investigate the effect of a laparoscopic versus open surgical approach to IHR on early postoperative morbidity and mortality in the obese population using the National Surgical Quality Improvement Program (NSQIP) database.

Methods

All IHRs were identified within the NSQIP database from 2005 to 2013. Obesity was defined as a body mass index ≥30 kg/m2. A propensity score matching technique between the laparoscopic and open approaches was used. Association of obesity with postoperative outcomes was investigated using an adjusted and unadjusted model based on clinically important preoperative variables identified by the propensity scoring system.

Results

A total of 7346 patients met inclusion criteria; 5573 patients underwent laparoscopic IHR, while 1773 patients underwent open IHR. On univariate analysis, obese patients who underwent laparoscopic IHR were less likely to experience a deep surgical site infection, wound dehiscence, or return to the operating room compared with those who underwent an open IHR. In both the adjusted and unadjusted propensity score models, there was no difference in outcomes between those who underwent laparoscopic versus open IHR.

Conclusions

The laparoscopic approach to IHR in obese patients has similar outcomes as an open approach with regard to 30-day wound events. Preoperative risk stratification of obese patients is important to determining the appropriate surgical approach to IHR. Further studies are needed to investigate the long-term effects of the open and laparoscopic approaches to IHR in the obese population.

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Acknowledgments

Dvir Froylich was involved in study concept and data analysis and wrote the manuscript; Ivy N. Haskins was involved in study concept and data analysis and wrote the manuscript; Ali Aminian was involved in study concept and final review; Colin P. O’Rourke was involved in data analysis; Zhamak Khorgami was involved in data analysis; Mena Boules was involved in study concept and original review; Gautam Sharma was involved in data analysis; Stacy A. Brethauer was involved in final review; Phillip R. Schauer was involved in study concept and final review; Michael J. Rosen was involved in study concept and final review.

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Authors and Affiliations

  1. The Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Dvir Froylich, Ali Aminian, Colin P. O’Rourke, Zhamak Khorgami, Mena Boules, Gautam Sharma, Stacy A. Brethauer & Phillip R. Schauer

  2. The Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Ivy N. Haskins & Michael J. Rosen

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  1. Dvir Froylich
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Correspondence to Dvir Froylich.

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Dr. Dvir Froylich, Dr. Ivy N. Haskins, Dr. Ali Aminian, Colin P. O’Rourke, Dr. Zhamak Khorgami, Dr. Mena Boules, Dr. Gautam Sharma, Dr. Stacy A. Brethauer, Dr. Phillip R. Schauer, and Dr. Michael J. Rosen have no conflicts of interest or financial ties to disclose.

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Froylich, D., Haskins, I.N., Aminian, A. et al. Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis. Surg Endosc 31, 1305–1310 (2017). https://doi.org/10.1007/s00464-016-5112-6

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