Emergent Laparoscopic Ventral Hernia Repairs.

J Surg Res 2018 12 2;232:497-502. Epub 2018 Aug 2.

Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina. Electronic address:

Background: Emergent repairs of incarcerated and strangulated ventral hernia repairs (VHR) are associated with higher perioperative morbidity and mortality than those repaired electively. Despite increasing utilization of minimally invasive techniques in elective repairs, the role for laparoscopy in emergent VHR is not well defined, and its feasibility has been demonstrated only in single center studies.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2009-2016) was queried for emergent VHR. Laparoscopic and open techniques were compared using univariate and multivariate analyses.

Results: A total of 11,075 patients who underwent emergent ventral and incisional hernia repairs were identified: 85.5% open ventral hernia repair (OVHR), 14.5% laparoscopic ventral hernia repair (LVHR). Patients who underwent emergent OVHRs were older, more comorbid, and more likely to be septic at the time of surgery than those undergoing emergent LVHRs. Emergent OVHR patients were more likely to have minor complications (22.1% versus 11.0%; OR 1.7; 95% CI 1.069-2.834). After controlling for confounding variables, LVHR and OVHR had similar outcomes, with the exception of higher rates of superficial surgical site infection in OVHR (5.0% versus 1.8%; odd's ratio (OR) 2.7; 95% confidence interval (CI) 1.176-6.138). Following multivariate analysis, laparoscopic approach demonstrated similar outcomes in major complications, reoperation, and 30-d mortality compared to open repairs. However, when controlling for other confounding factors, LVHR had reduced length of stay compared to OVHR (6.7 versus 4.0 d; 1.6 d longer, standard error 0.77, P < 0.03).

Conclusions: Emergent LVHR is associated with fewer superficial surgical site infection and shorter length of stay than OVHR but no difference in major complications, reoperation or 30-d mortality is associated with LVHR in the emergency setting.

Download full-text PDF

http://dx.doi.org/10.1016/j.jss.2018.07.034DOI Listing
December 2018
Save 15% Survey

Similar Publications

J-incision to approach the cranial abdomen in the adult horse.

Vet Surg 2021 Feb 24. Epub 2021 Feb 24.

Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA.

Objective: To describe a modified celiotomy to improve access to cranial abdominal structures in horses.

Animals: Four horses.

Study Design: Short case series. Read More

View Article and Full-Text PDF
February 2021

Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors.

J Pediatr Surg 2021 Feb 10. Epub 2021 Feb 10.

Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands; Medical Library, Vrije Universiteit, Amsterdam, Netherlands.

Purpose: Incisional hernia (IH) is a complication following abdominal surgery extensively studied in adults but less so in infants. This study aimed to identify the incidence, high risk diseases and risk factors of IH following abdominal surgery in infants.

Methods: Infants undergoing abdominal surgery before the age of three years in our tertiary centre between 1998 and 2018 were included. Read More

View Article and Full-Text PDF
February 2021

Management of complex ventral hernias: results of an international survey.

BJS Open 2021 Jan;5(1)

Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.

Background: The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice.

Methods: A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Read More

View Article and Full-Text PDF
January 2021

When to Stay Out of the Abdomen: Extending Extra-peritoneal Approaches to Complex Ventral and Incisional Hernias: A VIDEO BASED GUIDE TO THE TECHNIQUE.

J Trauma Acute Care Surg 2021 Feb 17. Epub 2021 Feb 17.

Minimally Invasive & Robotic Surgery, Trauma and Acute Care Surgery, Adventist Health Simi Valley Hospital, Simi Valley, California Trauma & Acute Care Surgery Service, Scripps Mercy Medical Center, San Diego, CA.

Background: Ventral and incisional hernias are common surgical pathologies managed by acute care surgeons, and also an area of explosion in repair options and approaches. Several new minimally invasive techniques have been developed to better tailor the repair to the individual patient and minimize the risk of intra-abdominal complications, particularly in patients with significant adhesions from prior surgery or trauma. The extended Totally Extra-peritoneal (eTEP) approach to incisional ventral hernias allows the repair of complex hernias while entirely avoiding entry into the peritoneal cavity. Read More

View Article and Full-Text PDF
February 2021

ROBotic Utility for Surgical Treatment of hernias (ROBUST hernia project).

Cir Esp 2021 Feb 15. Epub 2021 Feb 15.

Department of Surgery, Maria Middelares Ghent, Belgium; Department of Hepatobiliary Surgery, Maastricht UMC+, The Netherlands.

We describe the evolution in hernia repair approaches in our practice during the first 3 years of adopting robotic assisted laparoscopic surgery. For inguinal hernia repair, we began using the robotic platform for complex hernias, and the use of open repair decreased from 17% to 6%. For primary ventral hernias, open procedures decreased from 59% to 10% and for incisional ventral hernias, from 48% to 11%. Read More

View Article and Full-Text PDF
February 2021