Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 8/2020

01-08-2020 | Obesity | 2019 SAGES Oral

Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review

Authors: Kristen N. Williams, Lala Hussain, Angela N. Fellner, Katherine M. Meister

Published in: Surgical Endoscopy | Issue 8/2020

Login to get access

Abstract

Background

Currently, there’s not a well-accepted optimal approach for umbilical hernia repair in patients with obesity when comparing laparoscopic umbilical hernia repair (LUHR) versus open umbilical hernia repair (OUHR).

Objective

The objective of this study was to evaluate if there’s a difference in postoperative complications after LUHR versus OUHR with the goal of indicating an optimal approach.

Methods

A retrospective analysis was completed using the 2016 National Surgical Quality Improvement Program (NSQIP) database to identify patients with obesity (Body Mass Index (BMI) ≥ 30 kg/m2) who underwent LUHR or OUHR. Patients were divided into OUHR and LUHR groups, and post-operative outcomes were compared, focusing on wound complications.

Results

A total of 12,026 patients with obesity who underwent umbilical hernia repair were identified; 9695 underwent OUHR, while 2331 underwent LUHR. The LUHR group was found to have a statistically significant higher BMI (37.5 kg/m2 vs. 36.1 kg/m2; p < 0.01) and higher incidence of diabetes mellitus requiring therapy (18.4% vs. 15.8%; p < 0.01), hypertension (47.5% vs. 43.8%; p < 0.01), and current smoker status (18.6% vs. 16.5%; p < 0.02). Superficial surgical site infection (SSI) was significantly higher in the OUHR group (1.5% vs. 0.9%; p < 0.03), and there was a trend towards higher deep SSI in the OUHR group (0.3% vs. 0.5%; p = 0.147). There was no difference in organ space SSI, wound disruption, or return to OR. On logistic regression, composite SSI rate (defined as superficial, deep, and organ space SSIs) was significantly increased in the OUHR group (p < 0.01). Predictive factors significantly associated with increased morbidity included female gender and higher BMI.

Conclusions

In patients with obesity, even though the LUHR group had an overall higher BMI and higher rates of diabetes, hypertension, and current smoking status, they experienced decreased post-operative wound complications compared to the OUHR group.
Literature
1.
Muschaweck U (2003) Umbilical and epigastric hernia repair. Surg Clin North Am 83:1207–1221CrossRef
2.
Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL (2018) Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. JAMA 319:1723–1725CrossRef
3.
Menzo EL, Hinojosa M, Carbonell A, Krpata D, Carter J, Rogers AM (2018) American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 14:1221–1232CrossRef
4.
Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery; hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg 220:405–413CrossRef
5.
Buckley FP 3rd, Vassaur HE, Jupiter DC, Crosby JH, Wheeless CJ, Vassaur JL (2016) Influencing factors for port-site hernias after single-incision laparoscopy. Hernia 20:729–733CrossRef
6.
Lau B, Kim H, Haigh PI, Tejirian T (2012) Obesity increased the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg 78:1118–1121PubMed
7.
Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210:210–219CrossRef
8.
Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46CrossRef
9.
Sugerman H, Windsor A, Bessos M, Wolfe L (1997) Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med 24:71–79CrossRef
10.
Lambert DM, Marceau S, Forse RA (2005) Intra-abdominal pressure in the morbidly obese. Obes Surg 15:1225–1232CrossRef
11.
Varela JE, Hinojosa M, Nguyen N (2009) Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis 5:524–528CrossRef
12.
Noblett KL, Jensen JK, Ostergard DR (1997) The relationship of body mass index to intra-abdominal pressure as measured by a multichannel cystometery. Int Urogynecol J Plevic Floor Dysfunct 8:323–326CrossRef
13.
De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y (2008) Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 51:1806–1809CrossRef
14.
Aquina CT, Rickles AS, Probst CP, Kelly KN, Deeb AP, Monson JR, Fleming FJ; Muscle and Adiposity Research Consortium (MARC) (2015) Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum 58:220–227CrossRef
15.
Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560CrossRef
16.
Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L (2015) Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 37:88–99CrossRef
17.
Zajak J, Králiková E, Pafko P, Bortlíček Z (2013) Smoking and postoperative complications. Rozhl Chir 92:501–505PubMed
18.
McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780CrossRef
19.
Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386CrossRef
20.
Cassie S, Okrainec A, Saleh F, Quereshy F, Jackson T (2014) Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc 28:741–746CrossRef
21.
Wright BE, Beckerman J, Cohen M, Cumming JK, Rodriguez JL (2002) Is laparoscopic umbilical hernia repair with mesh a reasonable alternative to conventional repair? Am J Surg 184:505–508CrossRef
22.
Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical technicques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781
23.
Colon MJ, Kitamura R, Telem DA, Nguyen S, Divino CM (2013) Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 205:231–236CrossRef
24.
Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858CrossRef
25.
Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003) Laparoscopic versus open umbilical hernia repair. J Soc Laparoendoscop Surg 7:323–328
26.
Hajibandeh S, Hajibandeh S, Sreh A, Khan A, Subar D, Jones L (2017) Laparoscopic versus open umbilical or paraumbilical hernia repair: a systematic review and meta-analysis. Hernia 21:905–916CrossRef
27.
Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes. Am J Surg 210:1024–1029CrossRef
28.
Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N (2011) Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database. Ann Surg 254:641–652CrossRef
29.
Davis CH, Shirkey BA, Moore LW, Gaglani T, Du XL, Bailey HR, Cusick MV (2018) Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database. J Surg Res 223:16–21CrossRef
30.
Mandrioli M, Inaba K, Piccinini A, Biscardi A, Sartelli M, Agresta F, Catena F, Cirocchi R, Jovine E, Tugnoli G, Di Saverio S (2016) Advances in laparoscopy for acute care surgery and trauma. World J Gastroentero 22:668–680CrossRef
31.
Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P (2017) Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect 18:722–735CrossRef
32.
Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204:1178–1187CrossRef
Metadata
Title
Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review
Authors
Kristen N. Williams
Lala Hussain
Angela N. Fellner
Katherine M. Meister
Publication date
01-08-2020
Publisher
Springer US
Keywords
Obesity
Obesity
Published in
Surgical Endoscopy / Issue 8/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07129-7

Other articles of this Issue 8/2020

Surgical Endoscopy 8/2020 Go to the issue

Commentary

Commentary on Lineberry et al., The Fundamentals of Endoscopic Surgery (FES) skills test: factors associated with first-attempt scores and pass rate

2019 EAES Oral

Does endoscopic sleeve gastroplasty stand the test of time? Objective assessment of endoscopic ESG appearance and its relation to weight loss in a large group of consecutive patients

2019 SAGES Oral

Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs

OriginalPaper

Transabdominal (TA) versus totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair: a propensity score matching analysis

OriginalPaper

Anatomical study of gasless transoral thyroidectomy and clinical application

OriginalPaper

Superior pathologic and clinical outcomes after minimally invasive rectal cancer resection, compared to open resection