Laparoscopic Ventral Hernia Repair Safe in Obese Patients

Joe Barber Jr, PhD

June 12, 2013

Laparoscopic ventral hernia repair has significantly increased compared with open surgery. In addition to being safe, this type of repair is associated with a shorter length of stay and lower cost of care among obese patients, according to the findings of a retrospective cohort study.

Justin Lee, MD, from Tufts University School of Medicine in Boston, Massachusetts, and colleagues published their findings online June 12 in JAMA Surgery.

In the study, the researchers compared the use and outcomes of laparoscopic and open ventral hernia repair for 47,661 obese patients (BMI > 30 kg/m2) between 2008 and 2009 who were included in the Nationwide Inpatient Sample database. During the study period, the use of laparoscopic surgery increased by more than 4-fold from 6.5% in 2008 to 28.0% in 2009 (P < .001), whereas that of open surgery decreased from 93.5% to 72.0% (P < .001).

Patients who underwent laparoscopic surgery tended to be younger (aged 53.6 vs 54.9 years; P < .001) and more likely to have private insurance (52.0% vs 47.3%; P < .001). Conversely, patients with ventral hernias with obstruction (47.0% vs 43.9%; P < .001) or a gangrenous bowel (0.5% vs. 0.1%; P < .001) were more likely to undergo open surgery.

The laparoscopic group had a significantly shorter median length of stay (3 vs 4 days; P < .001) and lower total hospital charges ($40,387 vs $48,513; P < .001). The laparoscopic group also had a lower overall complication rate (6.3% vs 13.7%; P < .001) and lower rates of individual complications such as postoperative wound complications (0.1% vs 1.5%; P < .001) and postoperative pulmonary complications (2.4% vs 4.8%; P < .001).

In multivariate analysis adjusted for statistically significant variables such as private insurance and income, the presence of a gangrenous bowel was associated with a reduced likelihood of undergoing laparoscopic ventral hernia repair (odds ratio [OR], 0.14; 95% confidence interval [CI], 0.06 - 0.34; P < .001), whereas private insurance (OR, 1.20; 95% CI, 1.15 - 1.27; P < .001) and the highest median income quartile (OR, 1.26; 95% CI, 1.18 - 1.34; P < .001) were linked to a greater likelihood of undergoing laparoscopic surgery.

The limitations of the study include the inability to evaluate repeated hospital visits or follow long-term outcomes and a lack of information on the duration of presenting symptoms and intraoperative findings.

"Laparoscopy continues to be a safe and cost-effective surgical approach," the authors write. "Further studies are needed to define clinical criteria that may identify which obese patients with ventral hernias will benefit the most from a laparoscopic approach."

The authors have disclosed no relevant financial relationships.

JAMA Surg. Published online June 12, 2013.


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