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June 2012 Hernia Newsletter >>
Outcomes of Laparoscopic vs. Open Hernia Repair
In the short term, laparoscopic hernia repair is effective and associated with less morbidity, according to two recently published studies that evaluated outcomes of the approach vs. open repair.
Annals of Surgery: Short-term Outcomes of Laparoscopic vs. Open Abdominal Wall Hernia Repair
A recent study published in the Annals of Surgery compared 30-day outcomes after laparoscopic and open abdominal wall hernia repair.1
Using 2005-2009 data from the American College of Surgeons National Surgical Quality Improvement Program, the authors identified 71,054 patients who had undergone abdominal wall hernia repair. Of these patients, 17% had laparoscopic surgery and 83% had open surgery.
Patients who had laparoscopic repair experienced less overall morbidity (6.0% vs. 3.8%) or serious morbidity (2.5% vs. 1.6%) compared to open repair.
Overall morbidity was significantly lower for patients who had laparoscopic repair for strangulated and recurrent hernias (4.7% vs. 8.1%). Similarly, overall morbidity was significantly lower when the laparoscopic approach was used for umbilical (1.9% vs. 3.0%), ventral (3.9% vs. 6.3%), and incisional hernias (4.3% vs. 9.1%).
The authors concluded that although the laparoscopic approach is used much less frequently than the open approach, it is associated with lower short-term morbidity, especially for complicated hernias.
Cochrane Review: Laparoscopic vs. Open Ventral or Incisional Hernia Repair
A 2011 Cochrane Review evaluated 10 randomized controlled trials comparing laparoscopic with open repair in a total of 880 patients with (primary) ventral or incisional hernia.2
The review found no difference in hernia recurrence rates between the two approaches; however, in half of the trials, patient follow-up was less than 2 years.
It also found that wound infection was four times less likely to occur in patients who underwent laparoscopic repair compared with open repair. In 6 of 9 trials, hospital stays were significantly shorter for patients who had laparoscopic repair. There was no detectable difference in pain intensity between the two approaches.
The authors concluded that although short-term results of laparoscopic repair are promising, data on long-term effectiveness are still lacking. Further studies are necessary before considering the approach as the standard for primary ventral or incisional hernia repair.
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1. Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N. Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS–NSQIP database. Ann Surg. 2011 Oct;254(4):641-52. PubMed PMID: 21881493.