title: A single institutional comparison of endoscopic and open abdominal component separation.
abstract: BACKGROUND
  The authors analyzed surgical factors and outcomes data in the largest single institutional study comparing endoscopic (ECS) and open component separation (OCS) in ventral hernia repairs (VHR).
  
  
  METHODS
  A prospectively maintained database was reviewed, identifying 76 patients who underwent component separation for VHR with mesh from 2010 to 2013: 34 OCS and 42 ECS. Comparisons were made for demographics, surgical risk factors, and peri-operative outcomes. Wound complications and hernia occurrence post-operatively were reviewed. Risk analyses were performed to determine the association of pre-operative risk factors with surgical site occurrences.
  
  
  RESULTS
  Twenty-five ECS patients underwent subsequent laparoscopic hernia repair, and 17 underwent open repair. Operative time for ECS was longer than OCS (334 vs. 239 min; P < 0.001); however, there was no difference in length of stay (4 days in both groups, P = 0.64) and estimated blood loss (ECS: 97 vs. OCS: 93 cc, P = 0.847). In a sub-analysis of ECS patients, those who underwent laparoscopic hernia repair had a 96 min shorter operative time (P < 0.001) and lower EBL (63 vs. 147 cc, P < 0.001) than open repair. Wound complications were 24% in the ECS (n = 10) and 32% in OCS group (n = 11). There was one midline hernia recurrence in the ECS group (mean follow-up of 8 months, range 0.5-34.5 months) and no hernia recurrences in the OCS group (mean follow-up 10 months, range 0.5-30 months). Three of the patients in the ECS group developed new lateral abdominal wall hernias post-operatively.
  
  
  CONCLUSIONS
  The ECS group had a significantly longer operative time than the OCS group. Post-operative wound complications were similar between ECS and OCS groups. Patients in the ECS group who underwent subsequent laparoscopic VHR had a shorter operative time and blood loss than open repair.
authors: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 658, Baltimore, MD, 21287, USA, sazoury1@jhmi.edu.
authors: Saïd C
authors: SC
authors: Azoury
authors: Andrew P
authors: AP
authors: Dhanasopon
authors: Xuan
authors: X
authors: Hui
authors: Carla
authors: C
authors: De La Cruz
authors: Sami H
authors: SH
authors: Tuffaha
authors: Justin M
authors: JM
authors: Sacks
authors: Kenzo
authors: K
authors: Hirose
authors: Thomas H
authors: TH
authors: Magnuson
authors: Caiyun
authors: C
authors: Liao
authors: Monica
authors: M
authors: Lovins
authors: Michael A
authors: MA
authors: Schweitzer
authors: Hien T
authors: HT
authors: Nguyen
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome; D055815:Young Adult