Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity-matched study in large ventral hernias

Jenny M Shao; Eva B Deerenberg; Sharbel A Elhage; Paul D Colavita; Tanu Prasad; Vedra A Augenstein; Kent W Kercher; B Todd Heniford

doi:10.1007/s00464-020-07894-w

Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity-matched study in large ventral hernias

Surg Endosc. 2021 Aug;35(8):4653-4660. doi: 10.1007/s00464-020-07894-w. Epub 2020 Aug 11.

Authors

Jenny M Shao¹, Eva B Deerenberg¹, Sharbel A Elhage¹, Paul D Colavita¹, Tanu Prasad¹, Vedra A Augenstein¹, Kent W Kercher¹, B Todd Heniford²

Affiliations

¹ Department of Surgery, Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
² Department of Surgery, Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA. todd.heniford@gmail.com.

PMID: 32780243
DOI: 10.1007/s00464-020-07894-w

Abstract

Background: The merits of laparoscopic (LVHR) and open preperitoneal ventral hernia repair (OPPVHR) have been debated for more than 2 decades. Our aim was to determine peri-operative and long-term outcomes in large hernias.

Methods: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing LVHR and OPPVHR. One-to-one propensity score matching was performed for hernia defect size and follow-up.

Results: Three hundred and fifty-two LVHR and OPPVHR patients were identified with defect sizes closely matched between laparoscopic (182.0 ± 110.0 cm²) and open repairs (178.3 ± 99.8 cm²), p = 0.64. LVHR and OPPVHR patients were comparable: mean age 57.2 ± 12.1 vs 56.6 ± 12.0 years (p = 0.52), BMI: 32.9 ± 6.6 vs 32.0 ± 7.4 kg/m² (p = 0.16), diabetes 19.0% vs 19.7% (p = 0.87), and smoking history 8.7% vs 23.0% (p < 0.001), respectively. OPPVHR had higher number of recurrent hernias (14.2% vs 44.9%, p < 0.001), longer operative time (168.1 ± 64.3 vs 186.7 ± 67.7 min, p = 0.006), and more components separation (0% vs 20.3%, p < 0.001). Mean mesh size was larger (p < 0.001) in the open group (634.4 ± 243.4 cm² vs 841.8 ± 277.6 cm²). The hernia recurrence rates were similar (10.8% vs 9.2%, p = 0.62), with average follow-up of 39.3 ± 32.5 vs 40.0 ± 35.0 months (p = 0.89). Length of stay was higher in the OVHR cohort (5.4 ± 3.0 vs 6.3 ± 3.6 days, p < 0.001), but 30-day readmission rates (4.0% vs 6.4%, p = 0.31) were similar. Overall wound infection rate (2.9% vs 8.4%, p = 0.03) was higher in the OPPVHR group, but the mesh infection rate was similar between LVHR (1.7%) and OPPVHR (0.6%) (p = 0.33). Postoperative pain (41.1% vs 41.4%, p = 0.95) and overall QOL based on the Carolinas Comfort Scale at 6 months (p = 0.73) and 5-years (p = 0.36) were similar.

Conclusion: Laparoscopic and open preperitoneal repair for large ventral hernias have equivalent hernia recurrence rates, postoperative pain, and QOL on long-term follow-up. Patients undergoing OPPVHR were more likely to be recurrent, complex, require components separation, and more likely to develop postoperative wound complications.

Keywords: Laparoscopic; Open ventral hernia; Quality of life.

MeSH terms

Aged
Hernia, Ventral* / epidemiology
Hernia, Ventral* / surgery
Herniorrhaphy / adverse effects
Humans
Laparoscopy*
Middle Aged
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Prospective Studies
Quality of Life
Recurrence
Surgical Mesh
Treatment Outcome