Chetan Aher, MD, Shaun Daly, MD, Daniel J Deziel, MD, Keither W Millikan, MD, Jonathan A Myers, MD, Minh B Luu, MD. Department of Surgery Rush University Medical Center.
Introduction
Previous studies using ACS-NSQIP data demonstrated fewer complications associated with laparoscopic compared to open ventral hernia repair. Furthermore, the use of laparoscopy appeared to be low, accounting for only 17% of ventral hernia repairs. We hypothesize that despite these reports demonstrating advantages of laparoscopic compared to open techniques, the utilization of laparoscopy continues to remain low.
Methods
A retrospective review of the ACS-NSQIP database from 2009 to 2012 was conducted. All patients who underwent a laparoscopic or open hernia repair were included. The primary outcome was 30-day mortality. Secondary outcomes were associated 30-day morbidity that includes wound infections, respiratory complications, urinary tract infections, cardiac arrests requiring CPR, transfusions and sepsis. Data was evaluated with chi-squared analysis.
Results
A total of 107,431 patients undergoing a ventral hernia repair were identified. Laparoscopy was performed in 23% of the cases and open technique was performed in the remaining 77%. Patients undergoing laparoscopic repair were more likely to have one or two operative risk factors, while patients undergoing open repair were more likely to have zero or four or more risk factors. Laparoscopy was associated with lower mortality (0.2% vs 0.4%,p=0.001) and overall 30-day morbidity (4% vs. 7.4% p<0.0001). There were fewer wound (1.38% vs 4.33%, p<0.0001) or respiratory (1.7% vs 2.34%, p<0.001) complications associated with laparoscopic repair, and transfusion (0.48% vs 0.93% p<0.0001) and sepsis (0.55% vs 0.89%, p<0.0001) were both reduced with laparoscopy.
Conclusion
According to the ACS-NSQIP database, utilization of laparoscopy to repair ventral hernias has risen only 6% in recent years and remains low overall, despite decreased mortality and morbidity compared to the open technique. Whether this positive association is a function of laparoscopic procedure itself or a function of patient selection remains to be seen.