Is laparoscopic repair of incarcerated abdominal hernias safe?

Ahmad Elnahas, MD, FRCSC, Song Hon H Kim, MD, FRCSC, Allan Okrainec, MD, MHPE, FRCSC, FACS, Fayez Quereshy, MD, MBA, FRCSC, Timothy D Jackson, MD, MPH, FRCSC, FACS. University Health Network, Department of Surgery, University of Toronto

Introduction: There is a paucity of literature surrounding the safety and feasibility of laparoscopic repair for acutely incarcerated abdominal hernias. The objective of this study was to compare the 30-day morbidity and mortality between laparoscopic and open repairs of incarcerated abdominal hernias.

Methods and Procedures: A retrospective cohort study was conducted using data from the National Surgery Quality Improvement Program from 2005 to 2012. The study population was selected using ICD-9 diagnostic codes describing abdominal hernias with obstruction but without gangrene. Cases with documented bowel resection were excluded. Group classification was based on CPT coding. Study outcomes included the 30-day major complication, reoperation and mortality rates. Multivariable logistic regression models were used to adjust for confounding for all study outcomes.

Results: A total of 2688 and 15562 patients were in the laparoscopic and open group, respectively. After adjustment for clinically relevant confounders, laparoscopic surgery was associated with a significantly lower 30-day major complication rate (OR 0.66, p < .001, 95% CI [0.55 – 0.80]). However, there was no statistical difference with respect to the 30-day reoperation rate (OR 0.81, p = 0.28, 95% CI [0.56 – 1.18]) or mortality rate (OR 0.94, p = 0.80, 95% CI [0.58 – 1.53]).

Conclusions: Patients with incarcerated abdominal hernias who underwent laparoscopic repair had a significantly lower 30-day morbidity compared to patients with open repair. Although the 30-day reoperation and mortality rates were also lower, there was no statistically significant difference. Laparoscopic surgery appears to be safe in the management of select incarcerated abdominal hernias.

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