Outcomes of Laparoscopic vs Open Repair of Primary Ventral Hernias

Abstract

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.

Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications?

“…With the implementation of the IPOM technique the abdominal wall is not reconstructed according to the natural anatomy but augmented only. Recurrence rates of hernias after laparoscopic treatment described in the literature vary greatly from 11.4 to 18% in a followup of 17e65 months [30,31]. In accordance with these results, we were able to show a recurrence rate of 12% considering a median follow-up period of 29 months.…”

Ventral hernia: Patient selection, treatment, and management

“…Most report increased operative times with laparoscopic repair [66][67][68][69] . Some studies report no major differences in recurrence and complication rates 66,68 while others report decreased rates of wound infections 67,69-71 decreased length of stay 70 , decreased recurrence rates 72 , risk of port site hernia 71 and increased rates of post-operative bulging (eventration) at the repair site 71 with laparoscopic repair. Somewhat contradictory to several of the published studies, a retrospective review of the National Surgery Quality Improvement Program (NSQIP) database examining over 14,000 patients noted increased length of stay as well as increased rates of respiratory and cardiac complications with laparoscopic as compared to open repair of umbilical hernias 69 .…”

Laparoscopic Umbilical and Epigastric Hernia Repair

“…Even with the author's careful attempts to control for bias, this is a nonrandomized, unblinded cohort, and factors other than the matching criteria may be the most important determinates of surgical site infection. In this study, 3 the patients were almost all male, yet, nationally, nearly 50% of ventral hernia repairs are performed for female patients, and so the results of the study by Liang and colleagues 3 may not be generalizable to female patients. 2 Most importantly, a laparoscopic repair is likely to cost considerably more than an open repair, especially because patients who undergo a laparoscopic repair require a longer length of hospital stay, and so the increased intraoperative costs will not be balanced out by a shorter hospital length of stay as is typically seen with comparisons between laparoscopic and open procedures.…”

“…Although ventral hernias are mostly thought of as incisional hernias, data from American College of Surgeons National Surgical Quality Improvement Program suggest that the majority of ventral hernias repaired are actually primary hernias. 2 Despite the strength of the findings, the results of this study 3 are far from definitive, and care must be exercised in interpreting the results. Even with the author's careful attempts to control for bias, this is a nonrandomized, unblinded cohort, and factors other than the matching criteria may be the most important determinates of surgical site infection.…”