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Original Investigation |

Laparoscopic vs Open Ventral Hernia Repair in the Era of Obesity

Justin Lee, MD1; Allan Mabardy, MD1; Reza Kermani, MD1; Marvin Lopez, MD2; Nicole Pecquex, MD1; Anthony McCluney, MD1
[+] Author Affiliations
1Department of Surgery, St Elizabeth Medical Center, Tufts University School of Medicine, Boston, Massachusetts
2Department of Surgery, Jordan Cancer Center, Plymouth, Massachusetts
JAMA Surg. 2013;148(8):723-726. doi:10.1001/jamasurg.2013.1395.
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Importance  This study analyzes a role of laparoscopy in obese patients with ventral hernia.

Objective  To evaluate the outcomes of laparoscopic compared with open ventral hernia repair (VHR) in obese patients.

Design  Retrospective cohort analysis.

Setting  Nationwide hospital survey.

Participants  Obese patients undergoing VHR from 2008 through 2009 were selected from the Nationwide Inpatient Sample database.

Main Outcomes and Measures  Data analysis included intraoperative and postoperative complications, length of stay, and total hospital charges. Additional patient demographics, including insurance, median income, and locations, were analyzed.

Results  Of the 47 661 obese patients who underwent VHR during the study period, laparoscopic VHR increased more than 4-fold, from 1547 of 23 917 (6.5%) to 6629 of 23 704 (28.0%) (P < .001). Laparoscopic VHR was associated with a lower overall complication rate (6.3% vs 13.7%; P < .001), shorter median length of stay (3 vs 4 days; P < .001), and lower mean total hospital charges ($40 387 vs $48 513; P < .001). Multivariable logistic regression analysis identified a predictive variable for laparoscopic VHR: private insurance (odds ratio, 1.20; 95% CI, 1.15-1.27; P < .001). Ventral hernias with a gangrenous bowel were less likely to undergo laparoscopic VHR (odds ratio, 0.14; 95% CI, 0.06-0.34; P < .001).

Conclusions and Relevance  In the era of laparoscopy, the overall use of laparoscopic VHR in obese patients has increased significantly and appears to be safe, with a shorter stay and a lower cost of care.

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Figure.
National Trend of Laparoscopic vs Open Ventral Hernia Repair

Percent use of laparoscopic vs open ventral hernia repair depicted in the Nationwide Inpatient Sample trend from 2008 through 2009.

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