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Emergent Laparoscopic Ventral Hernia Repairs.

Angela M Kao1, Ciara R Huntington1, Javier Otero1

  • 1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.

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Summary
This summary is machine-generated.

Emergent laparoscopic ventral hernia repair (LVHR) shows fewer superficial infections and shorter hospital stays than open repair (OVHR). However, major complications, reoperation, and mortality rates are similar between laparoscopic and open approaches in emergency settings.

Keywords:
Abdominal wall repairEmergentIncarcerated herniaLaparoscopic versus openMinimally invasiveNSQIPVentral or incisional hernia repair

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Area of Science:

  • Surgical innovation
  • Minimally invasive surgery
  • Abdominal wall reconstruction

Background:

  • Emergent ventral hernia repairs (VHR) carry higher risks than elective procedures.
  • Laparoscopic techniques are increasingly used for elective VHR, but their role in emergent cases is less defined.
  • Previous studies on emergent laparoscopic VHR were limited to single centers.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of laparoscopic ventral hernia repair (LVHR) in emergent settings.
  • To compare laparoscopic versus open ventral hernia repair (OVHR) for emergent cases using a large national database.
  • To determine if laparoscopy offers advantages in emergent VHR regarding complications and length of stay.

Main Methods:

  • Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2009-2016).
  • Inclusion of 11,075 patients undergoing emergent ventral and incisional hernia repairs.
  • Comparison of laparoscopic ventral hernia repair (LVHR) and open ventral hernia repair (OVHR) using univariate and multivariate analyses.

Main Results:

  • Patients undergoing emergent OVHR were older, had more comorbidities, and were more likely to be septic than those undergoing LVHR.
  • Emergent OVHR had higher rates of minor complications (22.1% vs. 11.0%) and superficial surgical site infections (5.0% vs. 1.8%) compared to LVHR.
  • After multivariate analysis, LVHR demonstrated similar outcomes in major complications, reoperation, and 30-day mortality, but with a reduced length of stay (4.0 days vs. 6.7 days).

Conclusions:

  • Emergent laparoscopic ventral hernia repair (LVHR) is associated with fewer superficial surgical site infections and a shorter length of stay compared to open ventral hernia repair (OVHR).
  • Laparoscopic and open approaches show similar rates of major complications, reoperation, and 30-day mortality in the emergency setting.
  • The findings support the use of LVHR in emergent situations, offering potential benefits in specific complication types and resource utilization.