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Original Investigation
Association of VA Surgeons
November 2013

Outcomes of Laparoscopic vs Open Repair of Primary Ventral Hernias

Author Affiliations
  • 1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
  • 2Department of Statistics, Rice University, Houston, Texas
  • 3Department of Surgery, University of Texas Health Science Center at Houston
JAMA Surg. 2013;148(11):1043-1048. doi:10.1001/jamasurg.2013.3587
Abstract

Importance  More primary ventral hernias (PVHs) are being repaired using the technique of laparoscopic ventral hernia repair (LVHR). Few studies exist comparing the outcomes of LVHR with the outcomes of open ventral hernia repair (OVHR) for PVHs. We hypothesize that LVHR of PVHs is associated with fewer surgical site infections (SSIs) but more hernia recurrences and more clinical cases of bulging (bulging not associated with recurrence or seroma).

Objective  To compare the outcomes of patients who underwent LVHR with the outcomes of patients who underwent OVHR.

Design  Retrospective study of 532 consecutive patients who underwent an elective PVH repair at a single institution from 2000 to 2010. The outcomes of the 2 procedures were compared using 2 statistical methods. Multivariable logistic regression was used to evaluate the association between outcomes and several independent factors, adjusting for treatment propensity, and the outcomes in the 2 groups of patients were compared using paired univariate analysis.

Setting  Michael E. DeBakey VA Medical Center in Houston, Texas.

Participants  Seventy-nine patients who underwent LVHR and 79 patients who underwent OVHR.

Main Outcomes and Measures  The primary outcomes of interest were SSI, hernia recurrence, and bulging. The 2 groups of patients were matched by hernia size, American Society of Anesthesiologists class, age, and body mass index.

Results  There were 91 patients who underwent an LVHR and 167 patients who underwent an OVHR with mesh, with a median follow-up period of 56 months (range, 1-156 months). Seventy-nine patients with an LVHR were matched to 79 patients with an OVHR. No significant differences in demographic data or confounding factors were detected between the 2 groups. Compared with OVHR, LVHR was significantly associated with fewer SSIs (7.6% vs 34.1%; P < .01) but more clinical cases of bulging (21.5% vs 1.3%; P < .01) and port-site hernia (2.5% vs 0.0%). No differences in recurrence at the site of the hernia repair were observed (11.4% vs 11.4%; P = .99). Propensity score–matched multivariate analysis corroborated that LVHR is associated with more clinical cases of bulging but fewer SSIs.

Conclusions and Relevance  Compared with OVHR of PVHs, LVHR of PVHs is associated with fewer SSIs but more clinical cases of bulging and with the risk of developing a port-site hernia. Further study is needed to clarify the role of LVHR of PVHs and to mitigate the risk of port-site hernia and bulging.

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