Laparoscopic versus open ventral hernia repair in patients with chronic liver disease.

Abstract

Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients. Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors. A total of 3594 ventral hernia repairs were included, 536 (14.9%) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95% CI 0.07-0.74, p=0.01), shorter length of stay (mean 3.7 vs. 5.0days, p<0.01) than OVHR, but similar systemic complications (p=0.77), bleeding complications (p=0.69), unplanned reoperation (p=0.74) or readmission (p=0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2%) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95% CI 1.00-28.60, p=0.05), systemic complications (OR 7.03, 95% CI 2.06-24.00, p<0.01), and unplanned reoperation (OR 6.03, 95% CI 1.51-24.12, p=0.01) than OVHR. In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.