American Surgical Association

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Laparoscopic versus Open Anterior Abdominal Wall Hernia Repair: 30-Day Morbidity and Mortality using ACS/NSQIP Database
Rodney J Mason, MD*, Ashkan Moazzez, MD*, Namir Katkhouda, MD*, Helen Sohn, MD*, Thomas V Berne, MD
University of Southern California, Los Angeles, CA

OBJECTIVE:
To compare 30-day morbidity and mortality for laparoscopic and open abdominal wall hernia repair.

METHODS:
Using the ACS/NSQIP database (2005-2009), 71,026 patients who underwent an abdominal wall hernia repair were identified (17% laparoscopic, 83% open). The association between surgical approach and overall morbidity, serious morbidity and mortality was determined. Subgroup analysis between inpatient/outpatient surgery (n=28,315 / 42,711), strangulated/reducible (n=18,725 / 52,301) and initial/recurrent hernias as well as between umbilical (n=25,006), ventral (n=16,169) and incisional (n=29,851) hernias were performed.

RESULTS:
Patients undergoing a laparoscopic approach were significantly less likely to experience an overall morbidity, serious morbidity, or mortality compared with those who underwent an open repair (see Table).
Similar findings for these 3 outcomes were found in patients classified as in-patient. Patients with laparoscopically repaired strangulated hernia had significantly lower overall (4.7% vs. 8.1%, p<.0001) and serious morbidity. Patients with recurrent hernias repaired laparoscopic also had significantly better overall morbidity (4.1% vs. 12.2%, p<.0001) and serious morbidity. Significantly lower overall morbidity was also noted for the laparoscopic approach when the hernias were categorized into umbilical (1.9% vs. 3.0%,p=.009), ventral (3.9% vs. 6.3%,p<.0001) and incisional (4.3% vs. 9.1%,p<.0001). No differences were noted between laparoscopic and open repairs in patients undergoing outpatient surgery in patients with reducible hernias (n=32,919, 46%).
CONCLUSION:
Within ACS NSQIP hospitals, laparoscopic repair is infrequent and associated with lower 30-day morbidity and mortality.


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