title: Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients.
abstract: To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS).
  
  
  
  Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014.
  
  
  
  Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS.
  
  
  
  Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Soliani
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Troia
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Portinari
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Targa
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Carcoforo
authors.affiliation: University of Ferrara, Ferrara, Italy.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vasquez
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.|Boston VA Healthcare System, 1400 VFW Parkway (112), West Roxbury, MA, 02132, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Fisichella
authors.affiliation: University of Ferrara, Ferrara, Italy. cvfeo@unife.it.|Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy. cvfeo@unife.it.
authors.forename: C V
authors.identifier: 0000-0003-0699-5689
authors.initials: CV
authors.lastname: Feo
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors
keywords: Cohort study; Cost and cost analysis; Herniorrhaphy; Incisional hernia; Laparoscopic surgery; Surgical mesh