title: Is laparoscopic repair of incarcerated abdominal hernias safe? Analysis of short-term outcomes.
abstract: There is a paucity of literature surrounding the safety and feasibility of laparoscopic repair for acutely incarcerated abdominal hernias. The objective of this study was to compare the 30-day morbidity and mortality between laparoscopic and open repairs of incarcerated abdominal hernias.
  
  
  
  A retrospective cohort study was conducted using data from the National Surgery Quality Improvement Program from 2005 to 2012. The study population was selected using ICD-9 diagnostic codes describing abdominal hernias with obstruction, but without gangrene. Cases with documented bowel resection were excluded. Group classification was based on CPT coding. Study outcomes included the 30-day major complication, reoperation and mortality rates. Multivariable logistic regression models were used to adjust for confounding for all study outcomes.
  
  
  
  A total of 2688 and 15,562 patients were in the laparoscopic and open group, respectively. After adjustment for clinically relevant confounders, laparoscopic surgery was associated with a significantly lower 30-day infectious (OR 0.36, p < 0.001, 95 % CI 0.23-0.56) and serious complication rates (OR 0.66, p < 0.001, 95 % CI 0.55-0.80). However, there was no statistical difference with respect to the 30-day reoperation (OR 0.81, p = 0.28, 95 % CI 0.56-1.18) or mortality rates (OR 0.94, p = 0.80, 95 % CI 0.58-1.53).
  
  
  
  Patients with incarcerated abdominal hernias who underwent laparoscopic repair had a significantly lower 30-day morbidity compared to patients with open repair. Although the 30-day reoperation and mortality rates were also lower, there was no statistically significant difference. Laparoscopic surgery appears to be safe in the management of select incarcerated abdominal hernias.
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. ahmadelnahas@gmail.com.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Elnahas
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors.forename: Song Hon H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors.forename: Fayez
authors.initials: F
authors.lastname: Quereshy
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D046449:Hernia, Abdominal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Abdominal hernias; Incarceration; Laparoscopy; Obstruction