Abstract
Purpose
Patients with liver cirrhosis may require inguinal hernia repair. It is unknown if surgical approach, laparoscopic or open, affects outcomes in this high-risk patient population. This study compares complications, deaths, and length of stay between open and laparoscopic inguinal hernias in patients with liver disease.
Methods
All patients (N = 145,780) who were diagnosed with inguinal hernia (ICD-9-codes: 550.00, 550.02, 550.10, 550.12, 550.90, and 550.92) and had unilateral repair surgery (current procedure codes: 49505, 49507, 49525, and 49650) between 2005 and 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Data collected included patient demographics, comorbid conditions, postsurgical diagnosis, and outcomes. Multivariate logistic regression models were employed to evaluate the associations between various outcomes and surgical approach.
Results
The percentage of open inguinal hernia repair (OIHR) decreased from 84.08% in 2005 to 74.66% in 2014. The mean MELD score was 9.09 ± 4.02 among open surgery patient group, which was higher than the mean MELD score (8.03 ± 2.78) among laparoscopic surgery group. After propensity score matching for patient characteristics, open and laparoscopic inguinal hernia groups had similar length of stay with a slightly longer operation time being observed among laparoscopic group. Overall complications rates were similar (OR 0.87, 95% CI 0.–1.15, p = 0.32) as was overall mortality (0.27% among open surgery patients and 0.12% among laparoscopic patients, OR 0.42, 95% CI 0.15–1.21, p = 0.96).
Conclusion
Laparoscopic inguinal hernia repair demonstrates similar morbidity and mortality when compared to open repairs in patients with liver disease suggesting that both are viable repair options.
Similar content being viewed by others
References
Carbonell AM, Wolfe LG, DeMaria EJ (2005) Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. Hernia 9(4):353–357. doi:10.1007/s10029-005-0022-x
Delis S, Bakoyiannis A, Madariaga J, Bramis J, Tassopoulos N, Dervenis C (2010) Laparoscopic cholecystectomy in cirrhotic patients: the value of MELD score and Child-Pugh classification in predicting outcome. Surg Endosc 24(2):407–412. doi:10.1007/s00464-009-0588-y
Poggio JL, Rowland CM, Gores GJ, Nagorney DM, Donohue JH (2000) A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease. Surgery 127(4):405–411
McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:Cd001785. doi:10.1002/14651858.cd001785
Cavazzola LT, Rosen MJ (2013) Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 93(5):1269–1279. doi:10.1016/j.suc.2013.06.013
Trevisonno M, Kaneva P, Watanabe Y, Fried GM, Feldman LS, Andalib A, Vassiliou MC (2015) Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19(5):725–733. doi:10.1007/s10029-015-1358-5
Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R (2003) Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 124(1):91–96. doi:10.1053/gast.2003.50016
Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424. doi:10.1080/00273171.2011.568786
Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70(1):41–55. doi:10.1093/biomet/70.1.41
Parsons LS Performing a 1: N case-control match on propensity score. In: proceedings of the 29th Annual SAS users group international conference, 2004. SAS Institute, pp 165–129
Bhandarkar DS, Shankar M, Udwadia TE (2006) Laparoscopic surgery for inguinal hernia: current status and controversies. J Minim Access Surg 2(3):178–186
Willis B, Kim LT, Anthony T, Bergen PC, Nwariaku F, Turnage RH (2000) A clinical pathway for inguinal hernia repair reduces hospital admissions. J Surg Res 88(1):13–17. doi:10.1006/jsre.1999.5768
Saia M, Mantoan D, Buja A, Bertoncello C, Baldovin T, Zanardo C, Callegaro G, Baldo V (2013) Increased rate of day surgery use for inguinal and femoral hernia repair in a decade of hospital admissions in the Veneto Region (north-east Italy): a record linkage study. BMC Health Serv Res 13:349. doi:10.1186/1472-6963-13-349
Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, Volk ML (2015) The Epidemiology of Cirrhosis in the United States: a Population-based Study. J Clin Gastroenterol 49(8):690–696. doi:10.1097/mcg.0000000000000208
Hur YH, Kim JC, Kim DY, Kim SK, Park CY (2011) Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites. J Korean Surg Soc 80(6):420–425. doi:10.4174/jkss.2011.80.6.420
Oh HK, Kim H, Ryoo S, Choe EK, Park KJ (2011) Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg 35(6):1229–1233. doi:10.1007/s00268-011-1007-9 discussion 1234
Cho SW, Bhayani N, Newell P, Cassera MA, Hammill CW, Wolf RF, Hansen PD (2012) Umbilical hernia repair in patients with signs of portal hypertension: surgical outcome and predictors of mortality. Arch Surg 147(9):864–869. doi:10.1001/archsurg.2012.1663
Perkins L, Jeffries M, Patel T (2004) Utility of preoperative scores for predicting morbidity after cholecystectomy in patients with cirrhosis. Clin Gastroenterol Hepatol 2(12):1123–1128
Willoughby AD, Lim RB, Lustik MB (2016) Open versus laparoscopic unilateral inguinal hernia repairs: defining the ideal BMI to reduce complications. Surg Endosc. doi:10.1007/s00464-016-4958-y
Krafcik BM, Farber A, Eslami MH, Kalish JA, Rybin D, Doros G, King EG, Siracuse JJ (2016) The Role of the model of end-stage liver disease score in predicting outcomes of carotid endarterectomy. Vasc Endovascular Surg 50(6):380–384. doi:10.1177/1538574416655896
Krafcik BM, Farber A, Eslami MH, Kalish JA, Rybin D, Doros G, Shah NK, Siracuse JJ (2016) The role of model for end-stage liver disease (MELD) score in predicting outcomes for lower extremity bypass. J Vasc Surg 64(1):124–130. doi:10.1016/j.jvs.2016.01.033
Zielsdorf SM, Kubasiak JC, Janssen I, Myers JA, Luu MB (2015) A NSQIP analysis of MELD and perioperative outcomes in general surgery. Am Surg 81(8):755–759
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical Approval
This study conforms to ethical standards and is exempt by the institution’s human investigation committee.
Informed Consent
Informed consent was not obtained in this study involving deidentified, existing, publicly available national database.
Human and animal rights
This study was exempt by the institutional human investigation committee.
Rights and permissions
About this article
Cite this article
Pei, K.Y., Liu, F. & Zhang, Y. A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching. Hernia 22, 419–426 (2018). https://doi.org/10.1007/s10029-017-1693-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-017-1693-9