Complications in Laparoscopic Versus Open Incisional Ventral Hernia Repair. A Retrospective Comparative Study

The objective of the study was to evaluate peri- and postoperative outcomes, especially severe complications in adult incisional ventral hernia repair performed by open or laparoscopic surgery. Adult patients who were operated for incisional ventral hernias in two tertiary hospitals in Finland during 2006-2012 were included in the study. Clinical data were collected from patient registers. Peri- and postoperative parameters were gathered and compared between open and laparoscopic groups. Postoperative complications were analyzed, and the focus was on major complications. The results of 818 hernioplasties were evaluated: 291 (36.3 %) open and 527 (63.7 %) laparoscopic operations. In the laparoscopic group, the number of patients with postoperative complications was slightly lower (18.4 vs. 23.4 %, p = 0.090), and there were significantly fewer surgical site infections (3.2 vs. 8.6 %, p = 0.001). Twelve major complications occurred. In the laparoscopic group, four of the five major complications were consequences of undetected enterotomies, leading to reoperations, longer hospital stays, and death of one patient. Major complications in the open group consisted of four cardiac infarctions and three septic surgical site infections. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. Laparoscopic operations had a lower mean blood loss (13 vs. 31.5 ml, p = 0.028), and hospital stay (4 vs. 6 days, p = 0.001) compared to open operations. Laparoscopic incisional ventral hernia repair has a low rate of postoperative complications but it is associated with an increased risk of undetected enterotomies, in particular during cases involving adhesiolysis.