P

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Umbilical hernias

Laparoscopic repair

Open repair

Post operative pain

Patients with umbilical hernias

Laparoscopic umbilical hernia repair

Open umbilical hernia repair

Return to daily activities

Patients undergoing umbilical hernia repair

Laparoscopic umbilical hernia surgery

Open umbilical hernia surgery

Recovery

Patients undergoing umbilical hernia surgery

Minimally invasive umbilical hernia repair

Reduced complications

Citation:

 Gonzalez, R., Mason, E., Duncan, T., Wilson, R., & Ramshaw, B. J. (2003). Laparoscopic versus open umbilical hernia repair. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 7(4), 323–328.

Type of article:

Retrospective cohort study

Abstract:

Background: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair.

Methods: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared.

Results: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques.

Conclusions:

LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR.

Key points:

• 3 studies were examined, laparoscopic repair, open repair with suture technique and open repair with mesh.
• 76 cases examined (32 – laparoscopic repair , 20- open repair with mesh, and 24- open suture repair technique)
• Results showed that there was no significant differences in postoperative complications between the three procedure. Return to normal activity was significantly shorter in the laparoscopic repair group when compared to the two open repair groups. The length of hospital stay was significantly higher in the open repair with mesh group, and there was no significant difference between the laparoscopic group and primary suture repair group.

Why I chose it:

I chose this article because it was a cohort study performed in the United States which is the primary study type I was looking to obtain. The results that were measured included all of the same outcomes that I was looking to examine. It also included the same intervention (laparoscopic umbilical hernia repair) and control group (open umbilical surgical repair) that I was aiming to study in my PICO question.

Citation:

Wright, B. E., Beckerman, J., Cohen, M., Cumming, J. K., & Rodriguez, J. L. (2002). Is laparoscopic umbilical hernia repair with mesh a reasonable alternative to conventional repair?. American journal of surgery, 184(6), 505–509. https://doi.org/10.1016/s0002-9610(02)01071-1

Type of article:

Retrospective cohort study

Abstract:

Background: Laparoscopic mesh repair has been advocated as treatment of choice for ventral hernias. The term “ventral hernia” refers to a variety of abdominal wall defects and laparoscopic papers have not reported defect specific analysis. The purpose of this study was to determine any advantages to laparoscopic mesh repair of umbilical hernias.

Methods: A retrospective review (January 1998 to April 2001) was made of patients undergoing umbilical hernia repair. Patients were categorized into three groups: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. Comparative analysis was performed.

Results: One-hundred and sixteen umbilical hernia repairs were performed in 112 patients: 30 laparoscopic mesh repairs, 20 open mesh repairs, and 66 open nonmesh repairs. The laparoscopic technique was used for larger defects and took more time with a trend toward fewer postoperative complications and recurrences.

Conclusions: Laparoscopic umbilical hernia repair with mesh presents a reasonable alternative to conventional methods of repair.

Key points:

•  Retrospective cohort review of 112 patients (30 laparoscopic mesh repairs, 20 open mesh repairs, and 66 open non mesh repairs)
• 13% of patients had complications in laparoscopic repair, 25% patients had complications in the open repair with mesh, and 21% of patients had complications with open repair without mesh. The recurrence rate (type of complication) was 0% in laparoscopic procedure, 5% in open procedure with mesh , and 6% in open procedure with no mesh.  The length of hospital stay which is an indicator for recovery and can be used to help assess the return to normal activity was shortest in the open procedure with no mesh, compared to the open procedure with mesh and the laparoscopic procedure with mesh. The length of hospital stay for the laparoscopic group with mesh was shorter than the open group with mesh.
• The study states that postoperative pain, return to work and overall patient satisfaction were not assessable retrospectively.
• Article reports that many other variables to consider when looking at outcomes or open vs laparoscopic repair. Larger defects are usually needing a mesh and are typically done laparoscopically which will also require a larger recovery time and could be more painful.

Why I chose it:

I chose this article because it was a USA based article, and was another retrospective cohort study. This article examined open vs laparoscopic umbilical hernia repairs which was my intervention and control group which I intended to examine. I also liked this article because it showed the other variables that contribute to the outcomes I was examining. Two large variables that can contribute to post operative pain, return to work status, and complications are the size of the defect and the need of a mesh graft. Reading this article gave me more insight that the outcomes I’m examining are not just dependable on the technique used but many other factors. I thought this helped tremendously in helping me answer my research question.

Citation:

Lee J, Mabardy A, Kermani R, Lopez M, Pecquex N, McCluney A. Laparoscopic vs Open Ventral Hernia Repair in the Era of Obesity. JAMA Surg. 2013;148(8):723–726. doi:10.1001/jamasurg.2013.1395

Type of article:

Retrospective cohort study

Abstract:

Importance: This study analyzes a role of laparoscopy in obese patients with ventral hernia

Objective: To evaluate the outcomes of laparoscopic compared with open ventral hernia repair (VHR) in obese patients.  

Design : Retrospective cohort analysis.      

Setting: Nationwide hospital survey.        

Participants: Obese patients undergoing VHR from 2008 through 2009 were selected from the Nationwide Inpatient Sample database. 

Main Outcomes and Measures: Data analysis included intraoperative and postoperative complications, length of stay, and total hospital charges. Additional patient demographics, including insurance, median income, and locations, were analyzed.

Results: Of the 47,661 obese patients who underwent VHR during the study period, laparoscopic VHR increased more than 4-fold, from 1547 of 23 917 (6.5%) to 6629 of 23 704 (28.0%) (P < .001). Laparoscopic VHR was associated with a lower overall complication rate (6.3% vs 13.7%; P < .001), shorter median length of stay (3 vs 4 days; P < .001), and lower mean total hospital charges ($40 387 vs $48 513; P < .001). Multivariable logistic regression analysis identified a predictive variable for laparoscopic VHR: private insurance (odds ratio, 1.20; 95% CI, 1.15-1.27; P < .001). Ventral hernias with a gangrenous bowel were less likely to undergo laparoscopic VHR (odds ratio, 0.14; 95% CI, 0.06-0.34; P < .001)          

Conclusions and Relevance: In the era of laparoscopy, the overall use of laparoscopic VHR in obese patients has increased significantly and appears to be safe, with a shorter stay and a lower cost of care.

Key points:

• Retrospective cohort analyses performed in the USA.
• Analyzing role of laparoscopic hernia repair in obese patients with ventral hernias
• Obesity is the largest risk factor for hernias, many patients with ventral are due to obesity.
• Umbilical hernias are a common type of ventral hernia just describing location of hernia at the umbilicus.
• Outcomes measured included complications, length of stay, and hospital charges.

Why I chose it:

I chose this article because it was based in the United States and though it discussed ventral hernias, umbilical hernias are a type of ventral hernia. Also it took into account obesity which are present in a large proportion of hernia patients especially the ones I have seen so far in my rotation. It also studies outcomes that I was looking for such as complications, length of stay (which is connected to return to activity and recovery). It also measured the cost of care and though it wasn’t included in my pico question I thought this was a very interesting outcome that I would like to include in further research regarding the topic. I thought this article had different contributions to my research that I was curious about and my first two articles didn’t examine.