Laparoscopic versus open ventral hernia repair in obese patients – A long term follow up.

Dvir Froylich, MD, Miriam Segal, MD, Adam Weinstein, MD, Kamal Hatib, MD, Eitan Shiloni, MD, David Hazzan Hazzan, MD. Carmel medical Center

Background:

Obese (body mass index (BMI) >30kg/m2) patients undergoing ventral hernia repair (VHR), are known to have a greater risk of peri-operative morbidity, as well as recurrence. A laparoscopic approach is thought to reduce the possible complications associated with this cohort of patients. The aim of this study is to analyze the peri-operative complications and recurrence rates after laparoscopic ventral hernia repair (LVHR) in this specific population, in comparison to patients that have undergone an open repair.

Methods:

Patients with a BMI >30kg/m2, who had undergone either a primary or incisional ventral hernia repair (VHR) between 2004 and 2012 were analyzed retrospectively. Patients that underwent an emergent operation, or repair for more than one recurrence were excluded. Data collected included demographics, peri-operative complications, and recurrence rates were compared between the two approaches. Hernia size was divided to three categories (small, medium and large). Prospective evaluation of recurrence in these patients was conducted through physical examinations, and through pre-existing imaging modalities primarily CT scans upon availability.

Results:

A total of 186 patients that had undergone VHR were included, 37 of them had LVHR. The following parameters of age, gender, ASA score, BMI, and rates of primary or incisional ventral hernia repair were constant in both groups. Majority of the laparoscopic repairs in comparison to open repairs were conducted on large sized hernias (48.6% (LVHR) vs. 28.9% (open repair) (p=0.022)). Operative duration was significantly longer in LVHR (102 vs. 67 min (p<0.0001)). No significant differences are reported in our data in regards to peri-operative complications (18.9% vs. 20.1%, p=0.86). However, there were higher wound related complications in the open group (8.1% vs. 16.7%, p=0.187). After a mean follow-up period of 50 (LVHR) and 62 (open repair) months (p=0.42) the recurrence rates were greater in the open approach, but didn’t report statistical significance (18.9% vs. 27%, p=0.285). Furthermore, a conditional logistic regression analysis that accounts for the difference in followup time revealed that younger age was an independent risk factor for hernia recurrence (p=0.013). In addition, open repair was found to be a predictor for hernia recurrence (O.R 2.7, C.I 0.88-8.24).

Conclusion:

This study found hernia recurrence and wound related complications to be more likely in obese patients who undergo an open hernia repair. We believe the laparoscopic approach should be considered as the preferred technique for VHR in obese patients.