Laparoscopic versus open repair of parastomal hernias: An ACS-NSQIP analysis of short-term outcomes

Wissam J Halabi, Mehraneh D. Jafari, Joseph C. Carmichael, Vinh Q. Nguyen, Steven Mills, Michael Phelan, Michael J. Stamos, Alessio Pigazzi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)4067-4072
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

Fingerprint

Herniorrhaphy
Hernia
Length of Stay
Surgical Wound Infection
Operative Time
Laparoscopy
Emergencies
Multivariate Analysis
Regression Analysis
Morbidity
Recurrence
Mortality
Wounds and Injuries

Keywords

  • Colorectal
  • Hernia
  • Laparoscopy
  • NSQIP
  • Ostomy
  • Parastomal
  • Peristomal
  • Short-term outcomes
  • Stoma

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic versus open repair of parastomal hernias : An ACS-NSQIP analysis of short-term outcomes. / Halabi, Wissam J; Jafari, Mehraneh D.; Carmichael, Joseph C.; Nguyen, Vinh Q.; Mills, Steven; Phelan, Michael; Stamos, Michael J.; Pigazzi, Alessio.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 11, 01.11.2013, p. 4067-4072.

Research output: Contribution to journalArticle

Halabi, Wissam J ; Jafari, Mehraneh D. ; Carmichael, Joseph C. ; Nguyen, Vinh Q. ; Mills, Steven ; Phelan, Michael ; Stamos, Michael J. ; Pigazzi, Alessio. / Laparoscopic versus open repair of parastomal hernias : An ACS-NSQIP analysis of short-term outcomes. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 11. pp. 4067-4072.
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abstract = "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.",
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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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