title: Laparoscopic versus open repair of parastomal hernias: an ACS-NSQIP analysis of short-term outcomes.
abstract: BACKGROUND
  Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited.
  
  
  METHODS
  The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis.
  
  
  RESULTS
  Among the 2,167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p < 0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p < 0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p < 0.05), shorter length of hospital stay by 3.32 days (p < 0.001), lower risk of overall morbidity (OR = 0.42; p < 0.001), and a lower risk of surgical site infections (OR = 0.35; p < 0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29).
  
  
  CONCLUSIONS
  Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.
authors.affiliation: Department of Surgery, University of California- Irvine, 333 City Blvd West Suite 850, Orange, CA, 92868, USA, wissamhalabi@gmail.com.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Michael
authors.initials: M
authors.lastname: Phelan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D000368:Aged; D005260:Female; D006547:Hernia / Q000209:etiology*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D054047:Surgical Stomas / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome