title: A comparative analysis between laparoscopic and open ventral hernia repair at a tertiary care center.
abstract: Laparoscopic ventral hernia repair reportedly yields lower postoperative complications than open repair. We hypothesized that patients undergoing laparoscopic repair would have lower postoperative infectious outcomes. Also, certain preoperative patient characteristics and preoperative  hernia characteristics are hypothesized to increase complication risk in both groups. All ventral hernia repairs performed at University of Virginia from January 2004 to January 2006 were reviewed. Primary outcomes included wound healing complications and hernia recurrence. Categorical data  were analyzed with χ(2) and Fisher's exact tests. Continuous variables were evaluated with independent t tests and Mann-Whitney U tests. Multivariable logistic regression was performed. A total of 268 repairs (110 open, 158 laparoscopic) were evaluated. Patient and  hernia characteristics were similar between groups, though the percents of wound contamination (5.4% vs 0.6%; P = 0.02) and simultaneous surgery (7.2% vs 0%; P = 0.001) were greater in the open procedures. Univariate analysis also revealed that open cases had a  greater incidence of postoperative superficial surgical site infection (SSI) (30.0% vs 10.7%; P < 0.0001). Multivariable analysis revealed that both diabetes and open repair were associated with an increased risk of superficial SSI (P = 0.019; odds ratio = 3.512; 95%  confidence interval = 1.229-10.037 and P = 0.001; odds ratio = 4.6; 95% confidence interval = 1.9-11.2, respectively). Laparoscopic ventral hernia repair yielded lower rates of postoperative superficial SSI than open surgery. Other preoperative patient characteristics  and preoperative hernia characteristics, with the exception of diabetes, were not found to be associated with an increased risk of postoperative complications.
authors.affiliation: Department of General Surgery, University of Virginia, Charlottesville, Virginia, USA. sd2wf@virginia.edu
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Davies
authors.forename: Kristin C
authors.initials: KC
authors.lastname: Turza
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Schirmer
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology; D014945:Wound Healing