A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching.

Abstract

Patients with liver cirrhosis may require inguinal hernia repair. It is unknown if surgical approach, laparoscopic or open, affects outcomes in this high-risk patient population. This study compares complications, deaths, and length of stay between open and laparoscopic inguinal hernias in patients with liver disease. All patients (N=145,780) who were diagnosed with inguinal hernia (ICD-9-codes: 550.00, 550.02, 550.10, 550.12, 550.90, and 550.92) and had unilateral repair surgery (current procedure codes: 49505, 49507, 49525, and 49650) between 2005 and 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Data collected included patient demographics, comorbid conditions, postsurgical diagnosis, and outcomes. Multivariate logistic regression models were employed to evaluate the associations between various outcomes and surgical approach. The percentage of open inguinal hernia repair (OIHR) decreased from 84.08% in 2005 to 74.66% in 2014. The mean MELD score was 9.09±4.02 among open surgery patient group, which was higher than the mean MELD score (8.03±2.78) among laparoscopic surgery group. After propensity score matching for patient characteristics, open and laparoscopic inguinal hernia groups had similar length of stay with a slightly longer operation time being observed among laparoscopic group. Overall complications rates were similar (OR 0.87, 95% CI 0.-1.15, p=0.32) as was overall mortality (0.27% among open surgery patients and 0.12% among laparoscopic patients, OR 0.42, 95% CI 0.15-1.21, p=0.96). Laparoscopic inguinal hernia repair demonstrates similar morbidity and mortality when compared to open repairs in patients with liver disease suggesting that both are viable repair options.