G Soliani1,2, A De Troia1,2, M Portinari1,2, S Targa1,2, P Carcoforo1,2, G Vasquez1,2, P M Fisichella3,4, C V Feo5,6. 1. University of Ferrara, Ferrara, Italy. 2. Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy. 3. Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. 4. Boston VA Healthcare System, 1400 VFW Parkway (112), West Roxbury, MA, 02132, USA. 5. University of Ferrara, Ferrara, Italy. cvfeo@unife.it. 6. Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy. cvfeo@unife.it.
Abstract
PURPOSE: To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). METHODS: Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. RESULTS: Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. CONCLUSIONS: Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.
PURPOSE: To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). METHODS: Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. RESULTS: Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. CONCLUSIONS: Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.
Authors: Francisco Asencio; Javier Aguiló; Salvador Peiró; Juan Carbó; Ramón Ferri; Federico Caro; Marwan Ahmad Journal: Surg Endosc Date: 2008-12-31 Impact factor: 4.584
Authors: Peder Rogmark; Ulf Petersson; Sven Bringman; Arne Eklund; Emmanuel Ezra; Dan Sevonius; Sam Smedberg; Johanna Osterberg; Agneta Montgomery Journal: Ann Surg Date: 2013-07 Impact factor: 12.969
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069
Authors: Susan O'Connell; Saiful Islam; Bernadette Sewell; Angela Farr; Laura Knight; Nadim Bashir; Rhiannon Harries; Sian Jones; Andrew Cleves; Greg Fegan; Alan Watkins; Jared Torkington Journal: Health Technol Assess Date: 2022-08 Impact factor: 4.106
Authors: Caleb J Fan; Hung-Lun Chien; Matthew J Weiss; Jin He; Christopher L Wolfgang; John L Cameron; Timothy M Pawlik; Martin A Makary Journal: Surg Endosc Date: 2018-02-26 Impact factor: 4.584
Authors: L Matthijs van den Dop; Gijs H J de Smet; Michaël P A Bus; Johan F Lange; Sascha M P Koch; Willem E Hueting Journal: Hernia Date: 2020-09-12 Impact factor: 4.739