Comparing Surgical Outcomes Following Elective Laparoscopic Inguinal Hernia Repair Across Bmi Cohorts

Tyler Hall, BA¹, Lava Patel, MD¹, Matt Gitelis¹, Brittany Lapin, PhD¹, Zeeshan Butt, PhD², John G Linn, MD¹, Stephen P Haggerty, MD, FACS¹, Woody Denham, MD¹, Michael Ujiki, MD, FACS¹. ¹NorthShore University HealthSystem, ²Northwestern University Feinberg School of Medicine

Objective: Obesity has been shown to increase risk of postoperative complications following open inguinal hernia repair. Additionally, studies suggest 30 day clinical outcomes for obese patients do not differ between laparoscopic and open repairs. However, limited data exist comparing outcomes between BMI cohorts following laparoscopic inguinal hernia repair (LIHR). The aim of our study was to compare quality of life trends and clinical outcomes following LIHR across three BMI cohorts, BMI<25.0, BMI 25.0-30.0, and BMI>30.0. We hypothesize that unlike open procedures, LIHR will not result in significantly divergent outcomes between BMI cohorts.

Methods: A retrospective review of a prospectively maintained database identified 623 patients who underwent LIHR between 2009 – 2015. Cases were performed by four surgeons at a single institution using totally extra-peritoneal (TEP). Quality of life outcomes were measured using Short Form-36 (SF-36), Surgical Outcomes Measurement System (SOMS), and Carolinas Comfort Scale (CCS) surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years post- operatively. Comparisons between BMI cohorts were made using a chi-square test or t-test. Changes over time were assessed using mixed effects models.

Results: A cohort of 623 patients underwent elective LIHR and completed a validated quality of life survey. The three BMI cohorts exhibited different gender compositions (88.5% vs. 96.2% vs. 92.1% male, p<0.01), ASA classes (1.8 vs. 1.9 vs. 2.1, p<0.01) and smoking statuses (Table 1). The cohorts also differed in OR times (37.0 vs. 39 vs. 44.0 minutes, p=0.01). There were no differences in postoperative complications, including recurrence (0.8% vs. 2.7% vs. 2.9%, p=0.28).Despite no significant difference in preoperative pain scores, SOMS scores for VAS pain differed at 1 year (0.1 vs. 1.5 vs. 0.2, p=0.03). Table 2 shows CCS scores.

Conclusion: Elevated BMI was not found to be a risk factor for postoperative clinical complications following LIHR using TEP technique. However, the three cohorts did exhibit divergent quality of life outcomes at both short- and long-term intervals.