Laparoscopic hernia repair linked with lower rate of surgical infection

Image: PD 

1. Compared with open ventral hernia repair, laparoscopic ventral hernia repair had a lower rate of surgical site infection (7.6% vs 34.1%). 

2. Laparoscopic ventral hernia repair had a higher rate of postoperative ileus, bulging, and port-site hernias, as compared to open repair. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Ventral hernia repair is one of the most common surgical procedures, and laparoscopic ventral hernia repair (LVHR) has been increasing in popularity. However, there is limited evidence to support the use of LVHR over open ventral hernia repair (OVHR). This study demonstrated that the occurrence of surgical site infection (SSI) is lower in LVHR compared to OVHR, but LVHR had more cases of postoperative ileus, complaints of bulging, and port-site hernia recurrence than OVHR. The limitations of the study include the retrospective nature of the study, which could allow for biases in cohort selection. Moreover, the study was conducted at a Veteran’s Affairs hospital with primarily male patients, making the study less generalizable to other populations. Finally, the individual surgeon proficiency and experience could affect patient outcomes.

Click to read the study in JAMA Surgery

Relevant Reading: Epidemiology and cost of ventral hernia repair: making the case for hernia research

In-Depth [retrospective cohort]: This study examined 532 patients who underwent primary ventral hernia repair at a Veteran’s Affairs hospital between 2000 and 2010. The study included patients who had a mesh repair, while patients with suture repair were excluded. Of those included, 91 patients underwent an LVHR, and 165 underwent OVHR. Of the 91 LVHR patients, 79 were matched to 79 OVHR patients, based on hernia size, age, American Society of Anesthesiologists classification, and BMI. Those matched patients tended to be obese, with large hernia defects. Median follow-up length was 56 months.

Overall, patients who had an LVHR had a lower rate of SSI than those who had an OVHR (7.6% vs 34.2%, p<0.01). However, LVHR had a higher rate of postoperative ileus (10.1% vs 1.3%, p=0.05). There was also a higher rate of bulging (21.5% vs 1.3%, p<0.01) and port site hernia (2 patients vs 0 patients). Bulging was defined as patient complaint or clinician assessment of bulging not related to hernia reoccurrence or seroma. The rate of central hernia reoccurrence was the same in both groups (11.4%).

By James Jiang and Allen Ho

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