K N Williams, MD, L Hussain, MSc, MHA, K Meister, MD. TriHealth
Introduction: There's currently not a well-accepted optimal procedure for umbilical hernia repair (UHR) in patients with obesity when comparing laparoscopic repair (LR) versus open repair (OR). The purpose of this study was to evaluate if there is a difference in post-operative complications after LR versus OR with the goal of indicating an optimal approach.
Methods: A retrospective analysis was completed using the 2016 NSQIP database to identify patients with obesity (BMI >30) who underwent laparoscopic or open UHR. Patients were divided into OR and LR groups, and post-operative outcomes were compared, focusing on wound complications.
Results: A total of 12,026 patients with obesity who underwent UHR were identified; 9,695 underwent OR, while 2,331 underwent LR. The LR group was found to have a statistically significant higher BMI (37.5 vs 36.1; p<0.01) and higher incidence of diabetes mellitus requiring therapy (18.4% vs 15.8%; P<0.01), hypertension (47.5% vs 43.8%; p<0.01), and current smoker status (18.6% vs 16.5%; p<0.02). The operative time was significantly longer in the LR group (70 vs 44 minutes; p<0.01). Superficial surgical site infection (SSI) was significantly higher in the OR group (1.5% vs 0.9%; p<0.03), and there was a trend towards higher deep SSI in the OR group (0.3% vs 0.5%; p=0.147). There was no difference in organ space SSI, wound disruption, nor return to OR. On logistic regression, morbidity (defined as superficial, deep, and organ space SSIs) was significantly increased in the OR group (p<0.01). Predicting factors significantly associated with increased morbidity included female gender and higher BMI.
Conclusion: In patients with obesity, even though the LR group had an overall higher BMI and higher rates of diabetes, hypertension, and current smoking status, they experienced decreased post-operative wound complications compared to the OR group.
| Outcomes | Laparoscopic (n=2331) |
Open (n=9695) |
P Value |
| Superficial SSI | 21(.9%) | 146(1.5%) | .026 |
| Deep SSI | 2(.1%) | 26(.3%) | .147 |
| Organ Space SSI | 2(.1%) | 13(.1%) | .750 |
| Wound Disruption | 1(.0%) | 12(.1%) | .484 |
| Return to OR | 12(.5%) | 70(.7%) | .327 |
| Post-op Pneumonia | 9(.4%) | 12(.1%) | .012 |
| Post-op UTI | 9(.4%) | 24(.2%) | .269 |
| OR Time | 70±42 minutes | 44±32 minutes | <.001 |
| Morbidity | 25(1.1%) | 185(1.9%) | .002 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94253
Program Number: S099
Presentation Session: Inquinal and Ventral Hernia
Presentation Type: Podium