David Pechman, MD, MBA, Carmen Fong, MD, Paul Thodiyil, MD. Mount Sinai Beth Israel
Introduction: Multiple recent studies assessing the efficacy and safety of laparoscopic ventral hernia repair (LVHR) versus open ventral hernia repair (OVHR) show that LVHR is associated with decreased morbidity and shortened length of stay. The aim of this study was to assess outcomes after laparoscopic versus open approach in emergency ventral hernia repair.
Methods: We used data from the ACS-NSQIP database for the years 2012 and 2013 to compare patients who underwent laparoscopic emergent ventral hernia repair (LEVHR) versus open emergent ventral hernia repair (OEVHR) and identified patents by CPT code who underwent emergent umbilical, ventral, or incisional hernia repair. Length of stay and 30-day morbidity and mortality were compared for open versus laparoscopic repair. Statistical analyses were performed with either chi-square for categorical variables or unpaired t-test for continuous variables.
Results: A total of 329 patients underwent emergent repair of initial or recurrent umbilical, ventral, or incisional hernia. 31 /329 (9.4%) underwent LEVHR repair and 298 / 329 (90.6%) underwent OEVHR. Overall patient demographics and comorbid conditions were similar between groups, however the most severely-ill patients (American Society of Anesthesiology class 4) were more likely to undergo OVHR. LEVHR was associated with decreased superficial surgical site infection (0% vs. 5.7%, p < 0.05) and shortened length of stay (2.9 vs. 5.2 days from OR to discharge, p < 0.05). These associations persisted when subgroup analysis performed for ASA classes 1, 2, and 3; subgroup analysis was not possible for ASA class 4 (only 1 patient underwent LEVHR). 30-day mortality, deep surgical site infection, and rates other organ-specific morbidity did not differ significantly between groups.
Conclusion: This study supports the consideration of a laparoscopic approach to emergent ventral hernia repair and suggests that LEVHR may decrease morbidity and length of stay for patients with ASA 1, 2, and 3. As laparoscopy continues to be more widely implemented, consideration for LEVHR may also be appropriate in more critically-ill patients as well.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80542
Program Number: S102
Presentation Session: Acute Care Surgery
Presentation Type: Podium