Laparoscopic vs open ventral hernia repair in the era of obesity.

Abstract

This study analyzes a role of laparoscopy in obese patients with ventral hernia. To evaluate the outcomes of laparoscopic compared with open ventral hernia repair (VHR) in obese patients. Retrospective cohort analysis. Nationwide hospital survey. Obese patients undergoing VHR from 2008 through 2009 were selected from the Nationwide Inpatient Sample database. 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. 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). 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.