title: Outcomes of laparoscopic vs open repair of primary ventral hernias.
abstract: OBJECTIVE
  More primary ventral hernias (PVHs) are being repaired using the technique of laparoscopic ventral hernia repair (LVHR). Few studies exist comparing the outcomes of LVHR with the outcomes of open ventral hernia repair (OVHR) for PVHs. We hypothesize that LVHR of PVHs is associated with fewer surgical site infections (SSIs) but more hernia recurrences and more clinical cases of bulging (bulging not associated with recurrence or seroma).
  
  
  OBJECTIVE
  To compare the outcomes of patients who underwent LVHR with the outcomes of patients who underwent OVHR.
  
  
  METHODS
  Retrospective study of 532 consecutive patients who underwent an elective PVH repair at a single institution from 2000 to 2010. The outcomes of the 2 procedures were compared using 2 statistical methods. Multivariable logistic regression was used to evaluate the association between outcomes and several independent factors, adjusting for treatment propensity, and the outcomes in the 2 groups of patients were compared using paired univariate analysis.
  
  
  METHODS
  Michael E. DeBakey VA Medical Center in Houston, Texas.
  
  
  METHODS
  Seventy-nine patients who underwent LVHR and 79 patients who underwent OVHR.
  
  
  METHODS
  The primary outcomes of interest were SSI, hernia recurrence, and bulging. The 2 groups of patients were matched by hernia size, American Society of Anesthesiologists class, age, and body mass index.
  
  
  RESULTS
  There were 91 patients who underwent an LVHR and 167 patients who underwent an OVHR with mesh, with a median follow-up period of 56 months (range, 1-156 months). Seventy-nine patients with an LVHR were matched to 79 patients with an OVHR. No significant differences in demographic data or confounding factors were detected between the 2 groups. Compared with OVHR, LVHR was significantly associated with fewer SSIs (7.6% vs 34.1%; P < .01) but more clinical cases of bulging (21.5% vs 1.3%; P < .01) and port-site hernia (2.5% vs 0.0%). No differences in recurrence at the site of the hernia repair were observed (11.4% vs 11.4%; P = .99). Propensity score-matched multivariate analysis corroborated that LVHR is associated with more clinical cases of bulging but fewer SSIs.
  
  
  CONCLUSIONS
  Compared with OVHR of PVHs, LVHR of PVHs is associated with fewer SSIs but more clinical cases of bulging and with the risk of developing a port-site hernia. Further study is needed to clarify the role of LVHR of PVHs and to mitigate the risk of port-site hernia and bulging.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Berger
authors.forename: Linda T
authors.initials: LT
authors.lastname: Li
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Hicks
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
mesh_terms: D015992:Body Mass Index; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome