Laparoscopic versus open parastomal hernia repair: An ACS-NSQIP analysis of short-term outcomes

Wissam J Halabi, MD, Mehraneh D Jafari, MD, Vinh Q Nguyen, PhD, Joseph C Carmichael, MD, FACS, FASCRS, Steven Mills, MD, FACS, FASCRS, Micheal J Stamos, MD, FACS, FASCRS, Alessio Pigazzi, MD, PhD, FACS

University of California-Irvine, Medical Center Department of Surgery

Parastomal hernia is a frequent complication following the performance of an ostomy. A significant number of cases require operative management. Available data on the use of laparoscopy in the management of parastomal hernia is limited.

Using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2010, we performed a retrospective analysis of cases that underwent open or laparoscopic repair of a parastomal hernia. Variables such as patient age, gender, BMI, comorbidities, ASA class, wound class, and surgery type (elective vs. emergency) were listed. These were adjusted for on multivariate analysis. Outcomes were compared using linear and logistic regression.

Of the 1,720 identified cases, only 174 (10.12%) were performed laparoscopically. Mean patient age was 63 years in the open group and 64 years in the laparoscopic group. The majority of patients were female: 55.2% in the open group and 62.1% in the laparoscopic group. Compared to open repair, laparoscopy was associated with shorter operative times (138 vs. 151 minutes; p<0.05). On multivariate regression analysis, laparoscopic parastomal hernia repair was independently associated with shorter length of hospital stay by 3.6 days (mean difference: 2.7-4.5 days; p<0.01), lower risk of overall morbidity AOR=0.35 (95%CI: 0.21-0.57; p<0.01), and lower risk of surgical site infections AOR=0.28 (95%CI: 0.14-0.60; p<0.01). No mortality occurred in laparoscopic group whereas it was 1.62% in the open group.

Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results.

Session: Podium Presentation

Program Number: S071

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