Arash Azin1, Dhruvin Hirpara1, Timothy Jackson1,2, Allan Okrainec1,2, Ahmad Elnahas1,2, Sami A Chadi1,2, Fayez A Quereshy3,4,5. 1. Division of General Surgery, University of Toronto, Toronto, ON, Canada. 2. Division of General Surgery, University Health Network, Toronto, ON, Canada. 3. Division of General Surgery, University of Toronto, Toronto, ON, Canada. Fayez.Quereshy@uhn.ca. 4. Division of General Surgery, University Health Network, Toronto, ON, Canada. Fayez.Quereshy@uhn.ca. 5. Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room 8MP-320, Toronto, ON, M5T 2S8, Canada. Fayez.Quereshy@uhn.ca.
Abstract
BACKGROUND: The safety of emergent laparoscopic repair of incarcerated ventral hernias is not well established. The objective of this study was to determine if emergent laparoscopic repair of incarcerated ventral hernias is comparable to open repair with respect to short-term clinical outcomes. METHODS: Patients undergoing emergency repair of an incarcerated ventral hernia with associated obstruction and/or gangrene were identified using the ACS-NSQIP 2012-2016 dataset. One-to-one coarsened exact matching (CEM) was conducted between patients undergoing laparoscopic and open repair. Matched cohorts were compared with respect to morbidity, mortality, readmission, reoperation, missed enterotomies, and length of stay. Missed enterotomy was defined as any re-operative procedure within 30 days that required resection of large or small bowel segments, based on CPT codes. Multivariate analysis was conducted to determine adjusted predictors of morbidity. RESULTS: A total of 1642 patients were identified after CEM. Laparoscopic compared to open repair was associated with a lower rate of 30-day wound-morbidity (OR 0.35, 95% CI 0.22-0.57, p < 0.001). Laparoscopic repair was not associated with lower 30-day non-wound morbidity (OR 0.73, 95% CI 0.51-1.06, p = 0.094). Laparoscopic repair was associated with shorter LOS (3.6 days vs. 4.3 days, p = 0.014). A higher rate of missed enterotomies was observed in the laparoscopic cohort (0.7% vs. 0.0%, p = 0.031). There were no group differences with respect to 30-day readmission, reoperation, or mortality. CONCLUSIONS: Emergency laparoscopic repair of incarcerated ventral hernias is associated with lower rates of wound-morbidity and shorter hospital stays compared to open repair. However, laparoscopic repair is associated with a higher rate of missed enterotomies; a rate which is low and comparable to elective non-incarcerated ventral hernia repairs.
BACKGROUND: The safety of emergent laparoscopic repair of incarcerated ventral hernias is not well established. The objective of this study was to determine if emergent laparoscopic repair of incarcerated ventral hernias is comparable to open repair with respect to short-term clinical outcomes. METHODS:Patients undergoing emergency repair of an incarcerated ventral hernia with associated obstruction and/or gangrene were identified using the ACS-NSQIP 2012-2016 dataset. One-to-one coarsened exact matching (CEM) was conducted between patients undergoing laparoscopic and open repair. Matched cohorts were compared with respect to morbidity, mortality, readmission, reoperation, missed enterotomies, and length of stay. Missed enterotomy was defined as any re-operative procedure within 30 days that required resection of large or small bowel segments, based on CPT codes. Multivariate analysis was conducted to determine adjusted predictors of morbidity. RESULTS: A total of 1642 patients were identified after CEM. Laparoscopic compared to open repair was associated with a lower rate of 30-day wound-morbidity (OR 0.35, 95% CI 0.22-0.57, p < 0.001). Laparoscopic repair was not associated with lower 30-day non-wound morbidity (OR 0.73, 95% CI 0.51-1.06, p = 0.094). Laparoscopic repair was associated with shorter LOS (3.6 days vs. 4.3 days, p = 0.014). A higher rate of missed enterotomies was observed in the laparoscopic cohort (0.7% vs. 0.0%, p = 0.031). There were no group differences with respect to 30-day readmission, reoperation, or mortality. CONCLUSIONS: Emergency laparoscopic repair of incarcerated ventral hernias is associated with lower rates of wound-morbidity and shorter hospital stays compared to open repair. However, laparoscopic repair is associated with a higher rate of missed enterotomies; a rate which is low and comparable to elective non-incarcerated ventral hernia repairs.
Authors: Jacqueline J Choi; Nandini C Palaniappa; Kai B Dallas; Tamara B Rudich; Modesto J Colon; Celia M Divino Journal: Ann Surg Date: 2012-01 Impact factor: 12.969
Authors: Mylan T Nguyen; Rachel L Berger; Stephanie C Hicks; Jessica A Davila; Linda T Li; Lillian S Kao; Mike K Liang Journal: JAMA Surg Date: 2014-05 Impact factor: 14.766
Authors: Benjamin K Poulose; William C Beck; Sharon E Phillips; Kenneth W Sharp; William H Nealon; Michael D Holzman Journal: Am Surg Date: 2013-08 Impact factor: 0.688
Authors: Hasan H Eker; Bibi M E Hansson; Mark Buunen; Ignace M C Janssen; Robert E G J M Pierik; Wim C Hop; H Jaap Bonjer; Johannes Jeekel; Johan F Lange Journal: JAMA Surg Date: 2013-03 Impact factor: 14.766