Amelioration of the effects of obesity on short-term postoperative complications of laparoscopic and open ventral hernia repair

Jort F Fekkes, Vic Velanovich
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2015, 25 (2): 151-7

BACKGROUND: Recent studies indicate that laparoscopic ventral hernia repair has a lower incidence of postoperative surgical site infections (SSI) and length of stay (LOS). There is limited literature evaluating postoperative SSI, LOS, blood loss, and operation time (OT) in obese patients. The objective of this study was to compare postoperative SSI, LOS, blood loss, and OT in obese patients undergoing laparoscopic and open ventral hernia repair (OVHR).

MATERIALS AND METHODS: The American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) Participant Use File (PUF) from 2011 was used to identify patients with OVHR and laparoscopic ventral hernia repair (LVHR). Postoperative SSI, OT, LOS, and blood loss were analyzed and compared in the different patient groups using univariate and multivariate analyses.

RESULTS: A total of 12,004 patients who underwent ventral hernia repair were included in the study. The distribution of repair types were: 6537 (54.5%) reducible OVHR, 2749 (22.9%) incarcerated OVHR, 1767 (14.7%) reducible LVHR, and 763 (6.4%) incarcerated LVHR. Of the patients with body mass index (BMI) >30 kg/m 113 (3.4%) developed superficial SSI in the OVHR group compared with 7 (0.72%) of the patients in the LVHR group (P<0.01). The mean total OT was 77.9 minutes in the OVHR group, compared with 87.9 minutes LVHR for patients with BMI<25 kg/m. In the highest BMI class of >40 kg/m, OT was not significantly different between the groups. The mean LOS increased in OVHR group from 2.4 days in patients with BMI<25 kg/m to 3.7 days in patients with BMI>40 kg/m. In contrast, in the LVHR group, the LOS was decreased from a mean of 3.2 days in patients with BMI<25 kg/m to 1.9 days in patients with BMI>40 kg/m.

CONCLUSIONS: LVHR repair is related to a decreased risk for superficial SSI's and LOS in obese patients, without extending OT.

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