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Amelioration of the Effects of Obesity on the Short-Term Postoperative Complication Rate of Laparoscopic Compared to Open Ventral Hernia Repair
Jort Fekkes*, Vic Velanovich
Surgery, University of South Florida, Tampa, FL
Background: recent studies indicate that laparoscopic ventral hernia repair has a lower incidence of postoperative surgical site infections (SSI) and length of stay (LOS). There is limited literature evaluating postoperative SSI, (LOS), blood loss and operation time (OT) in obese patients. The objective of this study was to compare postoperative SSI, LOS, Blood loss and OT in obese patients undergoing laparoscopic and open ventral hernia repair.
Material and Methods: the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) The ACS-NSQIP is a large database collecting prospective clinical data on patients undergoing surgical procedures in hospitals across North America. The file from 2011 was used to identify patients with open and laparoscopic ventral hernia repair. Postoperative SSI, OT, LOS, and Blood loss was analyzed and compared in the different patient groups using univariate and multivariate analyses.
Results: a total of 12004 patients underwent ventral hernia repair. 6537 patients (54.5%) had reducible open incisional hernia repair; 2749 patients (22.9%) had an incarcerated open ventral hernia repair; 1767 patients (14.7%) had laparoscopic incisional hernia repair; 763 patients (6.4%) had incarcerated laparoscopic hernia repair; 188 patients (6.4%) had open hernia repair with mesh implant. 113 (3.4%) of the patients with BMI>30 kg/m2 were identified with superficial SSI's in open incisional hernia repair versus 7 (0.72%) of the patients with BMI>30 in laparoscopic incisional hernia repair (p<0.01). The mean total operation time in incisional ventral hernia repair versus laparoscopic ventral hernia repair for BMI<25kg/m2 was 77.9 minutes versus 87.9 minutes. In the highest BMI class >40kg/m2 operation time was not significant (p=0.6) longer in laparoscopic ventral hernia repair, laparoscopic versus open, 108.8 minutes versus 105.9 minutes. The mean length of stay increase in open ventral hernia repair, from 2.4 days in BMI<25kg/m2 to a mean of 3.7 days in patients with BMI>40kg/m2. In laparoscopic ventral hernia repair the length of stay was decreasing from a mean of 3.2 days in patients with BMI<25kg/m2 to a mean of 1.9 days in patients with BMI>40kg/m2.
Conclusion: Laparoscopic ventral hernia repair is related to a decreased risk for superficial SSI's and length of stay in obese patients, without extending operation time.
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