Laparoscopic vs open ventral hernia repair in the era of obesity

Abstract

Importance: This study analyzes a role of laparoscopy in obese patients with ventral hernia.

Objective: To evaluate the outcomes of laparoscopic compared with open ventral hernia repair (VHR) in obese patients.

Design: Retrospective cohort analysis.

Setting: Nationwide hospital survey.

Participants: Obese patients undergoing VHR from 2008 through 2009 were selected from the Nationwide Inpatient Sample database.

Main outcomes and measures: Data analysis included intraoperative and postoperative complications, length of stay, and total hospital charges. Additional patient demographics, including insurance, median income, and locations, were analyzed.

Results: Of the 47,661 obese patients who underwent VHR during the study period, laparoscopic VHR increased more than 4-fold, from 1547 of 23,917 (6.5%) to 6629 of 23,704 (28.0%) (P < .001). Laparoscopic VHR was associated with a lower overall complication rate (6.3% vs 13.7%; P < .001), shorter median length of stay (3 vs 4 days; P < .001), and lower mean total hospital charges ($40,387 vs $48,513; P < .001). Multivariable logistic regression analysis identified a predictive variable for laparoscopic VHR: private insurance (odds ratio, 1.20; 95% CI, 1.15-1.27; P < .001). Ventral hernias with a gangrenous bowel were less likely to undergo laparoscopic VHR (odds ratio, 0.14; 95% CI, 0.06-0.34; P < .001).

Conclusions and relevance: In the era of laparoscopy, the overall use of laparoscopic VHR in obese patients has increased significantly and appears to be safe, with a shorter stay and a lower cost of care.