Monday, December 10, 2012

Laparoscopic vs Open Ventral Hernia Repair

Dr Heniford's group down in North Carolina had a nice little paper out in the Annals of Surgery last month which prospectively studied quality of life (QoL) outcomes and complications in patients who had ventral hernias repaired either laparoscopically or at open surgery.  Both repair techniques incorporated the use of synthetic mesh. 

The conclusions are as follows:
  • Laparoscopic repairs are associated with lower short-term QoL scores and higher degrees of post operative pain
  • Long term recurrence and overall complication rates about the same
  • Fewer infections and shorter length of hospital stay with laparoscopic approach

This all sounds about right, based on my experience.  Laparoscopic ventral hernia repairs, without a doubt, lead to greater post-op pain in the initial 2-4 week healing phase.  Because the fascia is not closed laparoscopically, the patient experiences range of motion limitations and the perception of pain is deleteriously affected by a relatively unstable abdominal wall.  Conversely, all general surgeons can attest to the difficulty of managing wound infections after open hernia repair.  These cases can quickly degenerate into disasters----- potentially requiring mesh removal, re-laparotomy, and even bowel resection. 

My inclination is to opt for the laparoscopic approach, whenever feasible.  Wound issues and concerns about post op infections simply make open repair difficult to adopt as one's preferred technique.....

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