Javier Otero

Prospective, International Comparison of Quality of Life Outcomes After Laparoscopic vs Open Ventral Hernia Repair

RESULTS: A total of 1,221 repairs were performed, 578 LVHR and 643 OVHR, with a mean age of 56.9 years. Laparoscopic VHR was more frequently associated with females (57.2% vs 48.1%; p 1⁄4 0.002) and higher BMI (32.6 kg/m vs 31.0 kg/m; p < 0.0001), but other comorbidities were similar. Laparoscopic VHR had shorter length of stay (LOS, 2.8 2.4 days vs 4.3 5.1 days; p < 0.0001). Recurrences did not differ (5.7% vs 7.2%; p 1⁄4 0.3056). Wound complications were higher in OVHR (4.1% vs 0.4%; p < 0.0001), however, abdominal wall seromas and hematomas were increased in LVHR (16.6% vs 10.6%; p 1⁄4 0.002). The QOL at 1 month was worse for LVHR with regard to pain (odds ratio [OR], 1.98; 95% CI, 1.336-2.936), movement limitation (OR, 1.61; 95% CI, 1.076-2.402), and overall QOL (OR, 1.69; 95% CI, 1.1402.497). At 1 year, LVHR remained independently associated with increased pain (OR, 1.64; 95% CI, 1.025-2.624). No differences in QOL outcomes were noted at 2 years. Increased defect size was independently associated with worse overall postoperative QOL.

Deciding on Optimal Approach for Ventral Hernia Repair: Laparoscopic or Open

BACKGROUNDnThe decision to perform laparoscopic or open ventral hernia repair (VHR) is multifactorial. This study evaluates the impact of operative approach, BMI, and hernia size on outcomes after VHR.nnnSTUDY DESIGNnThe International Hernia Mesh Registry was queried for VHR (2007-2017). A predictive algorithm was constructed, factoring the impact of BMI, hernia size, age, sex, diabetes, and operative approach on outcomes.nnnRESULTSnOf the 1,906 VHRs, 58.8% were performed open, patient mean age was 54.9 ± 13.5 years, BMI was 31.2 ± 6.8 kg/m2, and defect area was 44.8 ± 88.1 cm2. Patients undergoing open VHRs were more likely to have an infection develop (3.1% vs 0.3%; p < 0.0001), but less likely to have a seroma develop (6.8% vs 15.3%; p < 0.0001) at mean follow-up 23.2 ± 12.0 months. With multivariate regression controlling for confounding variables, patients undergoing laparoscopic VHR had increased risk of seroma (odds ratio [OR] 1.78; 95% CI 1.05 to 3.03), a decreased risk of infection (OR 0.05; 95% CI 0.01 to 0.42), and had worse quality of life at 1, 6, 12, and 24 months postoperatively compared with patients undergoing open repair. Recurrent hernias were associated with subsequent recurrence (OR 2.69; 95% CI 1.24 to 5.81) and need for reoperation (OR 4.93; 95% CI 2.24 to 10.87). Multivariate predictive models demonstrated independent predictors of infection, including open approach, recurrent hernias, and low ratio of BMI to defect size.nnnCONCLUSIONSnIdeal outcomes are dependent on both patient and operative factors. Open repair in thin patients with large defects should be considered due to reduced complications and improved quality of life. Laparoscopic repair in obese patients and recurrent hernias can decrease the associated risk of infection.

Emergent Laparoscopic Ventral Hernia Repairs

BACKGROUNDnEmergent 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.nnnMETHODSnThe 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.nnnRESULTSnA 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%; odds 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 4.0xa0d; 1.6xa0d longer, standard error 0.77, Pxa0<xa00.03).nnnCONCLUSIONSnEmergent LVHR is associated with fewer superficial surgical site infection and shorter length of stay than OVHR but no difference in major complications, reoperation or 30-d mortality is associated with LVHR in the emergency setting.