Faculty Collaboration Database

Laparoscopic versus open ventral hernia repair in patients with chronic liver disease. Surg Endosc 2017 Feb;31(2):769-777

Date

06/24/2016

Pubmed ID

27334967

DOI

10.1007/s00464-016-5031-6

Scopus ID

2-s2.0-84975523110 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients.

METHODS: Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors.

RESULTS: A total of 3594 ventral hernia repairs were included, 536 (14.9 %) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95 % CI 0.07-0.74, p = 0.01), shorter length of stay (mean 3.7 vs. 5.0 days, p < 0.01) than OVHR, but similar systemic complications (p = 0.77), bleeding complications (p = 0.69), unplanned reoperation (p = 0.74) or readmission (p = 0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2 %) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95 % CI 1.00-28.60, p = 0.05), systemic complications (OR 7.03, 95 % CI 2.06-24.00, p < 0.01), and unplanned reoperation (OR 6.03, 95 % CI 1.51-24.12, p = 0.01) than OVHR.

CONCLUSIONS: In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.

Author List

Juo YY, Skancke M, Holzmacher J, Amdur RL, Lin PP, Vaziri K

Author

Jeremy H. Levin MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Chronic Disease
Databases, Factual
Elective Surgical Procedures
End Stage Liver Disease
Female
Hernia, Ventral
Herniorrhaphy
Humans
Incidence
Laparoscopy
Laparotomy
Length of Stay
Liver Cirrhosis
Liver Diseases
Male
Middle Aged
Mortality
Patient Readmission
Postoperative Complications
Postoperative Hemorrhage
Quality Improvement
Reoperation
Severity of Illness Index
Surgical Wound Infection