Emergent Laparoscopic Ventral Hernia Repairs

Emergent repairs of incarcerated and strangulated ventral hernia repairs (VHR) are associated with higher perioperative morbidity and mortality than those repaired electively. Despite increasing utilization of minimally invasive techniques in elective repairs, the role for laparoscopy in emergent VH...

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Bibliographic Details
Published in:The Journal of surgical research 2018-12, Vol.232, p.497-502
Main Authors: Kao, Angela M., Huntington, Ciara R., Otero, Javier, Prasad, Tanushree, Augenstein, Vedra A., Lincourt, Amy E., Colavita, Paul D., Heniford, Brant Todd
Format: Article
Language:English
Subjects:
Abdominal wall repair
Adult
Aged
Emergencies
Emergent
Female
Hernia, Ventral - surgery
Humans
Incarcerated hernia
Laparoscopic versus open
Laparoscopy - adverse effects
Laparoscopy - methods
Length of Stay
Male
Middle Aged
Minimally invasive
NSQIP
Surgical Wound Infection - epidemiology
Ventral or incisional hernia repair
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Summary:Emergent repairs of incarcerated and strangulated ventral hernia repairs (VHR) are associated with higher perioperative morbidity and mortality than those repaired electively. Despite increasing utilization of minimally invasive techniques in elective repairs, the role for laparoscopy in emergent VHR is not well defined, and its feasibility has been demonstrated only in single center studies. The American College of Surgeons National Surgical Quality Improvement Program database (2009-2016) was queried for emergent VHR. Laparoscopic and open techniques were compared using univariate and multivariate analyses. A total of 11,075 patients who underwent emergent ventral and incisional hernia repairs were identified: 85.5% open ventral hernia repair (OVHR), 14.5% laparoscopic ventral hernia repair (LVHR). Patients who underwent emergent OVHRs were older, more comorbid, and more likely to be septic at the time of surgery than those undergoing emergent LVHRs. Emergent OVHR patients were more likely to have minor complications (22.1% versus 11.0%; OR 1.7; 95% CI 1.069-2.834). After controlling for confounding variables, LVHR and OVHR had similar outcomes, with the exception of higher rates of superficial surgical site infection in OVHR (5.0% versus 1.8%; odd's ratio (OR) 2.7; 95% confidence interval (CI) 1.176-6.138). Following multivariate analysis, laparoscopic approach demonstrated similar outcomes in major complications, reoperation, and 30-d mortality compared to open repairs. However, when controlling for other confounding factors, LVHR had reduced length of stay compared to OVHR (6.7 versus 4.0 d; 1.6 d longer, standard error 0.77, P 
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2018.07.034