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Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients

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Abstract

Purpose

To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS).

Methods

Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014.

Results

Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3–4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS.

Conclusions

Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients’ characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

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Author information

Authors and Affiliations

  1. University of Ferrara, Ferrara, Italy

    G. Soliani, A. De Troia, M. Portinari, S. Targa, P. Carcoforo, G. Vasquez & C. V. Feo

  2. Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy

    G. Soliani, A. De Troia, M. Portinari, S. Targa, P. Carcoforo, G. Vasquez & C. V. Feo

  3. Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    P. M. Fisichella

  4. Boston VA Healthcare System, 1400 VFW Parkway (112), West Roxbury, MA, 02132, USA

    P. M. Fisichella

Authors
  1. G. Soliani
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  2. A. De Troia
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  3. M. Portinari
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  4. S. Targa
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  5. P. Carcoforo
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  8. C. V. Feo
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Contributions

Study conception and design: GS, MP, CVF. Acquisition of data: ADT, ST. Analysis and interpretation of data: GS, ADT, MP, PC, GV, PMF, CVF. Drafting of manuscript: ADT, CVF. Critical revision of the article: GS, MP, ST, PC, GV, PMF. Final approval of the article: GS, ADT, MP, ST, PC, GV, PMF, CVF. Statistical analysis: MP

Corresponding author

Correspondence to C. V. Feo.

Ethics declarations

Conflict of interest

GS, ADT, MP, ST, PC, GV, PMF, and CVF declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and later amendments or comparable ethical standards. For this type of study formal consent is not required.

Human and animal rights

This study granted an exception by the Ethical Committee for Human Subject Research at the S. Anna University Hospital

Informed consent

All patients provided a written informed consent for the surgical operation.

Funding

This study did not receive any funding.

Meeting presentation

The data of the manuscript were included in a poster presentation at the 1st World Conference on Abdominal Wall Hernia Surgery in Milan, Italy, April 25–29, 2015.

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Soliani, G., De Troia, A., Portinari, M. et al. Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients. Hernia 21, 609–618 (2017). https://doi.org/10.1007/s10029-017-1601-3

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  • DOI: https://doi.org/10.1007/s10029-017-1601-3

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