Nathan T Orr, MD, Daniel L Davenport, PhD, John S Roth, MD. University of Kentucky School of Medicine
Objective: An original article to compare the short-term outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair with laparoscopic cholecystectomy alone.
Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2009) using primary procedure and secondary CPT codes for laparoscopic cholecystectomy (LC) and laparoscopic ventral hernia repairs (LVHR). We analyzed outcomes for isolated LC and LVHR and simultaneous laparoscopic cholecystectomy and ventral hernia repair (LC/LVHR). The 30-day clinical outcomes along with post-operative LOS were assessed using chi-square and analysis of variance tests with p values < 0.01 set as significant. We also performed forward stepwise multivariable regression considering over 50 ACS NSQIP risk factors to adjust for patient risk.
Results: 82,837 patients underwent LC and/or LVHR of which 357 (0.4%) underwent simultaneous LC/LVHR. Patients undergoing LC/LVHR were more likely to have surgical site infections, suffer sepsis or septic shock, and have pulmonary complications including pneumonia, re-intubation or prolonged ventilator requirements than either LC or LVHR alone. No difference was noted in 30 day mortality, rates of DVT/PE, renal insufficiency, or stroke. After multivariable adjustment for over 50 ACS NSQIP risk factors, concurrent procedures continued to pose higher risk for these outcomes relative to LC only procedures.
| 30-d Outcome | LC Only | LVHR Only | LC/LVHR simultaneously |
Chi-square P-value |
| No. Cases | 74,019 | 8,818 | 357 | |
| Wound complications, % | 1.2 | 1.2 | 3.1 | 0.005 |
| Multivariate Odds Ratio | 1 reference |
1.46 (0.81-2.63) |
2.60** (1.42-4.78) |
|
| Sepsis or shock, % | 0.6 | 0.9 | 2.0 | <0.001 |
| Multivariate Odds Ratio | 1 reference |
1.82 (0.84-3.92) |
3.18** (1.44-7.01) |
|
| Pulmonary complications,% | 0.6 | 1.3 | 2.0 | <0.001 |
| Multivariate Odds Ratio | 1 reference |
2.44** (1.24-4.80) |
2.68* (1.19-6.05) |
|
| Postoperative LOS > 1d, % | 17.7 | 32.2 | 26.6 | <0.001 |
| Multivariate Odds Ratio | 1 reference |
6.96** (5.85-8.27) |
2.12** (1.62-2.77) |
* p <0.05; ** p <0.01
Conclusions: Simultaneous laparoscopic cholecystectomy and ventral hernia repair results in greater postoperative morbidity in terms of surgical site infections, sepsis, and pulmonary complications. In light of this increased short-term morbidity, consideration should be given toward performing laparoscopic cholecystectomy and laparoscopic ventral hernia repairs independently in patients requiring both procedures. Prospective studies with long-term follow up are required to better understand the implications of simultaneous laparoscopic cholecystectomy and ventral hernia repair.
Session Number: SS15 – Hernia
Program Number: S086