TY - JOUR
T1 - Laparoscopic versus open repair of parastomal hernias
T2 - An ACS-NSQIP analysis of short-term outcomes
AU - Halabi, Wissam J
AU - Jafari, Mehraneh D.
AU - Carmichael, Joseph C.
AU - Nguyen, Vinh Q.
AU - Mills, Steven
AU - Phelan, Michael
AU - Stamos, Michael J.
AU - Pigazzi, Alessio
PY - 2013/11/1
Y1 - 2013/11/1
N2 - Background Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited. Methods The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis. Results Among the 2, 167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p≤0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p≤0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p≤0.05), shorter length of hospital stay by 3.32 days (p≤0.001), lower risk of overall morbidity (OR = 0.42; p≤0.001), and a lower risk of surgical site infections (OR = 0.35; p≤0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29). Conclusions Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.
AB - Background Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited. Methods The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis. Results Among the 2, 167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p≤0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p≤0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p≤0.05), shorter length of hospital stay by 3.32 days (p≤0.001), lower risk of overall morbidity (OR = 0.42; p≤0.001), and a lower risk of surgical site infections (OR = 0.35; p≤0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29). Conclusions Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.
KW - Colorectal
KW - Hernia
KW - Laparoscopy
KW - NSQIP
KW - Ostomy
KW - Parastomal
KW - Peristomal
KW - Short-term outcomes
KW - Stoma
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U2 - 10.1007/s00464-013-3062-9
DO - 10.1007/s00464-013-3062-9
M3 - Article
C2 - 23836123
AN - SCOPUS:84892829123
VL - 27
SP - 4067
EP - 4072
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 11
ER -