title: Laparoscopic versus open ventral hernia repair in patients with chronic liver disease.
abstract: Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients.
  
  
  
  Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors.
  
  
  
  A total of 3594 ventral hernia repairs were included, 536 (14.9 %) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95 % CI 0.07-0.74, p = 0.01), shorter length of stay (mean 3.7 vs. 5.0 days, p < 0.01) than OVHR, but similar systemic complications (p = 0.77), bleeding complications (p = 0.69), unplanned reoperation (p = 0.74) or readmission (p = 0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2 %) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95 % CI 1.00-28.60, p = 0.05), systemic complications (OR 7.03, 95 % CI 2.06-24.00, p < 0.01), and unplanned reoperation (OR 6.03, 95 % CI 1.51-24.12, p = 0.01) than OVHR.
  
  
  
  In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA. yjuo@gwu.edu.
authors.forename: Yen-Yi
authors.initials: YY
authors.lastname: Juo
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Skancke
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Holzmacher
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lin
authors.affiliation: Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vaziri
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D058625:End Stage Liver Disease; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications*; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D058996:Quality Improvement; D012086:Reoperation; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Ascites; Chronic liver disease; Cirrhosis; Laparoscopic surgery; Ventral hernia repair