Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial.
BACKGROUND
Laparoscopic repair of ventral incisional hernias has not been proved to be safer than open mesh repair.


METHODS
Prospective randomized trial conducted between February 1, 2004, to January 31, 2007.


METHODS
Four Veterans Affairs medical centers.


METHODS
One hundred sixty-two patients with ventral incisional hernias.


METHODS
Standardized laparoscopic or open repair.


METHODS
Overall complication rates at 8 weeks and the odds of complications, adjusted for study site, body mass index, and hernia type.


RESULTS
Of the 162 randomized patients, 146 underwent surgery (73 open and 73 laparoscopic repairs). Complications were less common in the laparoscopic group (23 patients [31.5%]) compared with the open repair group (35 patients [47.9%]; adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.22-0.91; P = .03). Surgical site infection through 8 weeks was less common in the laparoscopic group (5.6% vs 23.3%; AOR, 0.2; 95% CI, 0.1-0.6). The mean worst pain score in the laparoscopic group was 15.2 mm lower on a visual analog scale at 52 weeks (95% CI, 1.0-29.3; P = .04). Time to resume work activities was shorter for the laparoscopic group than for the open repair group (median, 23.0 days vs 28.5 days), with an adjusted hazard ratio of 0.54 (95% CI, 0.28-1.04; P = .06). Overall recurrence at 2 years was 12.5% in the laparoscopic group and 8.2% in the open repair group (AOR, 1.6; 95% CI, 0.5-4.7; adjusted P = .44).


CONCLUSIONS
Laparoscopic repair was associated with fewer, albeit more severe, complications and improved some patient-centered outcomes. Trial Registration clinicaltrials.gov Identifier: NCT00240188.
Itani
Kamal M F
KM
Boston University, West Roxbury, Massachusetts, USA. kitani@va.gov
Hur
Kwan
K
Kim
Lawrence T
LT
Anthony
Thomas
T
Berger
David H
DH
Reda
Domenic
D
Neumayer
Leigh
L
D000368:Aged; D015992:Body Mass Index; D005260:Female; D006305:Health Status Indicators; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome