Laparoscopic versus open emergent ventral hernia repair: utilization and outcomes analysis using the ACSNSQIP...

Area of Science:

• Minimally Invasive Surgery
• Abdominal Wall Reconstruction
• Surgical Outcomes Research

Background:

• Laparoscopic ventral hernia repair (VHR) offers benefits over open repair, but its adoption in emergency cases is limited.
• The study investigates the underutilization of laparoscopy in emergent VHR.

Purpose of the Study:

• To evaluate the utilization of laparoscopic emergent ventral hernia repair (LEVHR) versus open emergent ventral hernia repair (OEVHR).
• To assess 30-day outcomes, including morbidity and mortality, for both LEVHR and OEVHR.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2006-2015).
• Compared LEVHR and OEVHR for incarcerated umbilical, ventral, or incisional hernias classified as emergencies.
• Assessed length of stay (LOS), 30-day morbidity, and mortality.

Main Results:

• Only 8.6% of 13,126 emergent VHR cases were laparoscopic (LEVHR).
• LEVHR demonstrated decreased operative time, shorter postoperative LOS, and reduced rates of superficial and deep surgical site infections (SSI).
• Subgroup analysis indicated lower incidence of SSI, wound disruption, pneumonia, and sepsis for lower-risk patients (ASA 1-3) undergoing LEVHR.

Conclusions:

• Laparoscopic utilization in emergent VHR remains low.
• LEVHR is associated with improved postoperative LOS and reduced infectious and wound-related complications.
• Increased adoption of LEVHR in emergency settings has the potential to significantly enhance patient outcomes.