0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Association of VA Surgeons

Outcomes of Laparoscopic vs Open Repair of Primary Ventral Hernias

Mike K. Liang, MD1; Rachel L. Berger, BA1; Linda T. Li, MD1; Jessica A. Davila, PhD1; Stephanie C. Hicks, PhD2; Lillian S. Kao, MD, MS3
[+] Author Affiliations
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2Department of Statistics, Rice University, Houston, Texas
3Department of Surgery, University of Texas Health Science Center at Houston
JAMA Surg. 2013;148(11):1043-1048. doi:10.1001/jamasurg.2013.3587.
Text Size: A A A
Published online

Importance  More primary ventral hernias (PVHs) are being repaired using the technique of laparoscopic ventral hernia repair (LVHR). Few studies exist comparing the outcomes of LVHR with the outcomes of open ventral hernia repair (OVHR) for PVHs. We hypothesize that LVHR of PVHs is associated with fewer surgical site infections (SSIs) but more hernia recurrences and more clinical cases of bulging (bulging not associated with recurrence or seroma).

Objective  To compare the outcomes of patients who underwent LVHR with the outcomes of patients who underwent OVHR.

Design  Retrospective study of 532 consecutive patients who underwent an elective PVH repair at a single institution from 2000 to 2010. The outcomes of the 2 procedures were compared using 2 statistical methods. Multivariable logistic regression was used to evaluate the association between outcomes and several independent factors, adjusting for treatment propensity, and the outcomes in the 2 groups of patients were compared using paired univariate analysis.

Setting  Michael E. DeBakey VA Medical Center in Houston, Texas.

Participants  Seventy-nine patients who underwent LVHR and 79 patients who underwent OVHR.

Main Outcomes and Measures  The primary outcomes of interest were SSI, hernia recurrence, and bulging. The 2 groups of patients were matched by hernia size, American Society of Anesthesiologists class, age, and body mass index.

Results  There were 91 patients who underwent an LVHR and 167 patients who underwent an OVHR with mesh, with a median follow-up period of 56 months (range, 1-156 months). Seventy-nine patients with an LVHR were matched to 79 patients with an OVHR. No significant differences in demographic data or confounding factors were detected between the 2 groups. Compared with OVHR, LVHR was significantly associated with fewer SSIs (7.6% vs 34.1%; P < .01) but more clinical cases of bulging (21.5% vs 1.3%; P < .01) and port-site hernia (2.5% vs 0.0%). No differences in recurrence at the site of the hernia repair were observed (11.4% vs 11.4%; P = .99). Propensity score–matched multivariate analysis corroborated that LVHR is associated with more clinical cases of bulging but fewer SSIs.

Conclusions and Relevance  Compared with OVHR of PVHs, LVHR of PVHs is associated with fewer SSIs but more clinical cases of bulging and with the risk of developing a port-site hernia. Further study is needed to clarify the role of LVHR of PVHs and to mitigate the risk of port-site hernia and bulging.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Patient Flowchart
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Computed Tomographic Scan Showing Continued Bulging of Preperitoneal Fat and Hernia Sac Following Laparoscopic Primary Ventral Hernia Repair
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Computed Tomographic Scan Showing Port-Site Hernia Recurrence and Recurrence at Site of Hernia Repair Following Laparoscopic Primary Ventral Hernia Repair
Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Photographs of the Technique of Laparoscopic Ventral Hernia Repair

Identification of primary ventral hernia (A), excision of hernia sac (B), excision of preperitoneal fat (C), and complete exposure of the hernia fascial edges (D).

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();