Title: A Study of incisional hernia repair at teaching tertiary care hospital - Laparoscopic vs. Open Repair
Authors: Dr Lalan Kumar, Dr Manish, Dr A.P. Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.186
Abstract
Importance: Incisional hernia is the most frequent surgical complication after laparotomy. Up to 11 -20% of all patients without wound complications develop an incisional hernia.
Objective: To compare laparoscopic vs. open ventral incisional hernia repair with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission, and recurrence rate.
Design: All patients with incisional hernia attending this hospital between September 2013 to March 2016 with a follow up at least 12 months were included in this study.
Setting: All patients were operated at the teaching hospital associated with ours institution.
Participants: sixty patients were randomized equally to laparoscopic or open mesh repair. Patients with an incisional hernia larger than 3 cm and smaller than 10 cm, either primary or recurrent, were included. Patients were excluded if they had an open abdomen treatment in their medical histories.
Intervention: Laparoscopic or open ventral incisional hernia repair.
Main Outcome Measures: The main outcome of the trial was postoperative pain. Secondary outcomes were use of analgesics, perioperative and postoperative complications, operative time, postoperative nausea, length of hospital stay, recurrence, morbidity, and mortality.
Results: Median blood loss during the operation was significantly less (15mL vs. 7 5mL; P = .05) as well as the number of patients receiving a wound drain (7% vs. 59%; P .001) in the laparoscopic group. Operative time for the laparoscopic group was longer (105 minutes vs. 78 minutes; P = .001). Perioperative complications were higher after laparoscopy (61% vs. 47%). Visual analog scale scores for pain and nausea, completed before surgery and 3 days and 1 and 4 weeks postoperatively, showed no significant differences between the 2 groups. At a mean follow-up period of 28 months, a recurrence rate of 9% was reported in the open group and 11%, in the laparoscopic group (P = .30). The size of the defect was found to be an independent predictor for recurrence (P .001).
Conclusions and Relevance: During the operation, there was less blood loss and less need for a wound drain in the laparoscopic group. Howeve, operative time was longer during laparoscopy. Perioperative complications were higher in the laparoscopic group. Visual analog scores for pain and nausea did not differ between groups. The incidence of a recurrence was similar in both groups. The size of the defect was found to be an independent factor for recurrence of an incisional hernia.
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