title: Laparoscopic umbilical hernia repair is the preferred approach in obese patients.
abstract: BACKGROUND
  The optimal method of umbilical hernia repair (UHR) in the obese population, laparoscopic vs open, is not standardized. The purpose of this study was to determine the optimal surgical option for UHR in the obese population.
  
  
  METHODS
  A retrospective chart review was conducted on 123 obese patients (body mass index [BMI] >30) who underwent UHR from 2003 to 2009 at a single institution. Patients were grouped by surgical approach (open vs laparoscopic). Intraoperative and postoperative courses were compared. Follow-up in the postoperative period was obtained from patient records and telephone interviews.
  
  
  RESULTS
  Of the 123 patients undergoing UHR, 40 and 83 patients were operated on with the laparoscopic and open approach, respectively. Patients were well matched by demographics as well as comorbidities. No difference in the mean BMI was shown between the laparoscopic and open groups (37 vs 35, P = not significant, respectively). The operative time was significantly prolonged in the laparoscopic group (106 vs 71 minutes, P < .01). Intraoperatively, no complications occurred in either group. In the immediate postoperative period, 1 patient who underwent laparoscopic UHR was readmitted for small bowel obstruction, and 2 patients in the open group were readmitted, 1 for pain control and 1 for wound infection. Follow-up was achieved in 63% of the laparoscopic group and 58% of the open group with a mean follow-up of 15 months in the laparoscopic group and 20 months in the open group (P = not significant). A significant increase in wound infection was reported in the open group with mesh insertion when compared with the laparoscopic procedure (26% vs 4%, P < .05, respectively). No hernia recurrence was shown in the laparoscopic vs the open group with mesh insertion (0% vs 4%, P = not significant, respectively).
  
  
  CONCLUSIONS
  In obese patients, the laparoscopic approach was associated with a significantly lower rate of postoperative infection and no hernia recurrence. Laparoscopic hernia repair may be the preferred option in the obese patient.
authors.affiliation: Department of Surgery, Division of General Surgery, The Mount Sinai Hospital, New York, NY, USA.
authors.forename: Modesto J
authors.initials: MJ
authors.lastname: Colon
authors.forename: Riley
authors.initials: R
authors.lastname: Kitamura
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Scott
authors.initials: S
authors.lastname: Nguyen
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D015992:Body Mass Index; D015897:Comorbidity; D017558:Elective Surgical Procedures; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D061646:Operative Time; D012107:Research Design; D012189:Retrospective Studies