Skip to main content
SpringerLink
Log in

Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The role of laparoscopic repair of ventral hernias remains incompletely defined. We hypothesize that laparoscopy, compared to open repair with mesh, decreases surgical site infection (SSI) for all ventral hernia types.

Methods

MEDLINE, EMBASE, and Cochrane databases were reviewed to identify studies evaluating outcomes of laparoscopic versus open repair with mesh of ventral hernias and divided into groups (primary or incisional). Studies with high risk of bias were excluded. Primary outcomes of interest were recurrence and SSI. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I 2), was encountered.

Results

There were 5 and 15 studies for primary and incisional cohorts. No difference was seen in recurrence between laparoscopic and open repair in the two hernia groups. SSI was more common with open repair in both hernia groups: primary (OR 4.17, 95 %CI [2.03–8.55]) and incisional (OR 5.16, 95 %CI [2.79–9.57]).

Conclusions

Laparoscopic repair, compared to open repair with mesh, decreases rates of SSI in all types of ventral hernias with no difference in recurrence. These data suggest that laparoscopic approach may be the treatment of choice for all types of ventral hernias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Attwood SE, Hill AD, Mealy K, Stephens RB (1992) A prospective comparison of laparoscopic versus open cholecystectomy. Ann R Coll Surg Engl 74:397–400

    CAS  PubMed Central  PubMed  Google Scholar 

  2. Purkayastha S, Tilney HS, Georgiou P, Athanasiou T, Tekkis PP, Darzi AW (2007) Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials. Surg Endosc 21:1294–1300. doi:10.1007/s00464-007-9210-3

    Article  PubMed  Google Scholar 

  3. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg 169:208–212 discussion 212–213

    Article  CAS  PubMed  Google Scholar 

  4. Hansen JB, Smithers BM, Schache D, Wall DR, Miller BJ, Menzies BL (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20:17–20 discussion 21

    Article  CAS  PubMed  Google Scholar 

  5. Coronini-Cronberg S, Appleby J, Thompson J (2013) Application of patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery in England. J R Soc Med 106:278–287. doi:10.1177/0141076813489679

    Article  PubMed Central  PubMed  Google Scholar 

  6. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400. doi:10.1016/j.amjsurg.2007.02.012

    Article  PubMed  Google Scholar 

  7. Qu H, Liu Y, He Q (2014) Short- and long-term results of laparoscopic versus open anti-reflux surgery: a systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg 18:1077–1086. doi:10.1007/s11605-014-2492-6

    Article  PubMed  Google Scholar 

  8. Salminen P, Hurme S, Ovaska J (2012) Fifteen-year outcome of laparoscopic and open Nissen fundoplication: a randomized clinical trial. Ann Thorac Surg 93:228–233. doi:10.1016/j.athoracsur.2011.08.066

    Article  PubMed  Google Scholar 

  9. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, Nakadi IE, Hauters P, Pascual MH, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Smietánski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. doi:10.1007/s10029-009-0518-x

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences? Hernia 14:383–387. doi:10.1007/s10029-010-0649-0

    Article  CAS  PubMed  Google Scholar 

  11. Subramanian A, Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Laparoscopic ventral hernia repair: primary versus secondary hernias. J Surg Res 181:e1–e5. doi:10.1016/j.jss.2012.06.028

    Article  PubMed  Google Scholar 

  12. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858. doi:10.1002/bjs.6668

    Article  CAS  PubMed  Google Scholar 

  13. Salvilla SA, Thusu S, Panesar SS (2012) Analysing the benefits of laparoscopic hernia repair compared to open repair: a meta-analysis of observational studies. J Minim Access Surg 8:111–117. doi:10.4103/0972-9941.103107

    Article  PubMed Central  PubMed  Google Scholar 

  14. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781

    PubMed  Google Scholar 

  15. Arroyo A, Garca P, Prez F, Andreu J, Candela F, Calpena R (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 88:1321–1323

    Article  CAS  PubMed  Google Scholar 

  16. Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J, Pappas TN, Lucas CE, Pellegrini CA, Easter DW, Fischer JE, Mathes SJ, Way LW, Debas HT, Jones RS (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585

    PubMed Central  PubMed  Google Scholar 

  17. Mekeel K, Mulligan D, Reddy KS, Moss A, Harold K (2007) Laparoscopic incisional hernia repair after liver transplantation. Liver Transpl 13:1576–1581. doi:10.1002/lt.21290

    Article  PubMed  Google Scholar 

  18. Bisgaard T, Kehlet H, Bay-Nielsen MB, Iversen MG, Wara P, Rosenberg J, Friis-Andersen HF, Jorgensen LN (2009) Nationwide study of early outcomes after incisional hernia repair. Br J Surg 96:1452–1457. doi:10.1002/bjs.6728

    Article  CAS  PubMed  Google Scholar 

  19. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. doi:10.1136/bmj.b2700

  20. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Liang MK, Berger RL, Li LT, Davila JA, Hicks SC, Kao LS (2013) Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surgery 148:1043–1048

    Article  PubMed  Google Scholar 

  22. Othman IH, Metwally YH, Bakr IS, Amer YA, Gaber MB, Elgohary SA (2012) Comparative study between laparoscopic and open repair of paraumbilical hernia. J Egypt Soc Parasitol 42:175–182

    Article  CAS  PubMed  Google Scholar 

  23. Solomon TA, Wignesvaran P, Chaudry MA, Tutton MG (2010) A retrospective audit comparing outcomes of open versus laparoscopic repair of umbilical/paraumbilical herniae. Surg Endosc 24:3109–3112. doi:10.1007/s00464-010-1097-8

    Article  CAS  PubMed  Google Scholar 

  24. Bencini L, Sanchez LJ, Boffi B, Farsi M, Martini F, Rossi M, Bernini M, Moretti R (2009) Comparison of laparoscopic and open repair for primary ventral hernias. Surg Laparosc Endosc Percutan Tech 19:341–344. doi:10.1097/SLE.0b013e31819756d7

    Article  PubMed  Google Scholar 

  25. Moreno-Egea A, Carrasco L, Girela E, Martìn J, Aguayo JL, Canteras M (2002) Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Arch Surg 137:1266–1268

    Article  PubMed  Google Scholar 

  26. Eker HH, Hansson BME, Buunen M, Janssen IMC, Pierik RE, Hop WC, Bonjer HJ, Jeekel J, Lange JF (2013) Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg 148:259–263. doi:10.1001/jamasurg.2013.1466

    Article  PubMed  Google Scholar 

  27. Marchesi F, Pinna F, Cecchini S, Sarli L, Roncoroni L (2011) Prospective comparison of laparoscopic incisional ventral hernia repair and Chevrel technique. Surg Laparosc Endosc Percutan Tech 21:306–310. doi:10.1097/SLE.0b013e31822b09a4

    Article  PubMed  Google Scholar 

  28. Kurmann A, Visth E, Candinas D, Beldi G (2011) Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg 35:297–301. doi:10.1007/s00268-010-0874-9

    Article  PubMed  Google Scholar 

  29. Itani KMF, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L, Investigators, Veterans Affairs Ventral Incisional Hernia (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145:322–328. doi:10.1001/archsurg.2010.18 discussion 328

    Article  PubMed  Google Scholar 

  30. Moreno-Egea A, Aguayo-Albasini JL, Ballester MM, Baldòo MJC (2009) Treatment of incisional hernias adopting an intra-abdominal approach with a new low-density composite prosthetic material: proceed: our preliminary experience on 50 cases. Surg Laparosc Endosc Percutan Tech 19:497–500. doi:10.1097/SLE.0b013e3181bd8d6f

    Article  PubMed  Google Scholar 

  31. Wolter A, Rudroff C, Sauerland S, Heiss MM (2009) Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences. Hernia 13:469–474. doi:10.1007/s10029-009-0508-z

    Article  CAS  PubMed  Google Scholar 

  32. Asencio F, Aguilò J, Peirò S, Carbò J, Ferri R, Caro F, Ahmad M (2009) Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc 23:1441–1448. DOI:10.1007/s00464-008-0230-4

  33. Ceccarelli G, Patriti A, Batoli A, Bellochi R, Spaziani A, Pisanelli MC, Casciola L (2008) Laparoscopic incisional hernia mesh repair with the double-crown technique: a case-control study. J Laparoendosc Adv Surg Tech A 18:377–382. doi:10.1089/lap.2007.0121

    Article  PubMed  Google Scholar 

  34. Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142:562–567. doi:10.1001/archsurg.142.6.562

    Article  PubMed  Google Scholar 

  35. Zografos GN, Mitropapas G, Vasiliadis G, Farfaras A, Ageli C, Margaris E, Tsipras I, Koliopanos A, Pateras J, Papastratis G (2007) Open and laparoscopic approach in incisional hernia repair with ePTFE prosthesis. J Laparoendosc Adv Surg Tech A 17:277–281. doi:10.1089/lap.2006.0082

    Article  PubMed  Google Scholar 

  36. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559. doi:10.1007/s00464-007-9229-5

    Article  CAS  PubMed  Google Scholar 

  37. Navarra G, Musolino C, Marco MLD, Bartolotta M, Barbera A, Centorrino T (2007) Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach. Surg Laparosc Endosc Percutan Tech 17:86–90. doi:10.1097/SLE.0b013e318030ca8b

    Article  PubMed  Google Scholar 

  38. Bencini L, Sanchez LJ, Boffi B, Farsi M, Scatizzi M, Moretti R (2003) Incisional hernia: repair retrospective comparison of laparoscopic and open techniques. Surg Endosc 17:1546–1551. doi:10.1007/s00464-002-9234-7

    Article  CAS  PubMed  Google Scholar 

  39. Chari R, Chari V, Eisenstat M, Chung R (2000) A case controlled study of laparoscopic incisional hernia repair. Surg Endosc 14:117–119

    Article  CAS  PubMed  Google Scholar 

  40. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821. doi:10.1067/msy.1998.92102 discussion 821–822

    Article  CAS  PubMed  Google Scholar 

  41. Shabanzadeh DM, Sorensen LT (2012) Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg 256:934–945. doi:10.1097/SLA.0b013e318269a46b

    Article  PubMed  Google Scholar 

  42. Tjandra JJ, Chan MKY (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388. doi:10.1111/j.1463-1318.2006.00974.x

    Article  CAS  PubMed  Google Scholar 

  43. Grailey K, Markar SR, Karthikesalingam A, Aboud R, Ziprin P, Faiz O (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19–30. doi:10.1007/s00464-012-2414-1

    Article  PubMed  Google Scholar 

  44. Cavazzola LT, Rosen MJ (2013) Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 93:1269–1279. doi:10.1016/j.suc.2013.06.013

    Article  PubMed  Google Scholar 

  45. Boni L, Benevento A, Rovera F, Dionigi G, Giuseppe MD, Bertoglio C, Dionigi R (2006) Infective complications in laparoscopic surgery. Surg Infect (Larchmt) 7(Suppl 2):S109–S111. doi:10.1089/sur.2006.7.s2-109

    Google Scholar 

  46. Maruszynski M, Pojda Z (1995) Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. A comparison of serum IL-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Surg Endosc 9:882–885

    CAS  PubMed  Google Scholar 

  47. Alexander AM, Scott DJ (2013) Laparoscopic ventral hernia repair. Surg Clin North Am 93:1091–1110

    Article  PubMed  Google Scholar 

  48. Hawn MT, Gray SH, Snyder CW, Graham LA, Finan KR, Vick CC (2011) Predictors of mesh explantation after incisional hernia repair. Am J Surg 202:28–33. doi:10.1016/j.amjsurg.2010.10.011

    Article  PubMed  Google Scholar 

  49. Liang MK, Li LT, Nguyen MT, Berger RL, Hicks SC, Kao LS, Liang MK (2014) Abdominal reoperation and mesh explantation following open ventral hernia repair with mesh. Am J Surg 208:670–676

    Article  PubMed  Google Scholar 

  50. Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217:974–982. doi:10.1016/j.jamcollsurg.2013.08.003

    Article  PubMed  Google Scholar 

  51. Le D, Deveney CW, Reaven NL, Funk SE, McGaughey KJ, Martindale RG (2013) Mesh choice in ventral hernia repair: so many choices, so little time. Am J Surg 205:602–607. doi:10.1016/j.amjsurg.2013.01.026 discussion 607

    Article  PubMed  Google Scholar 

  52. Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558. doi:10.1016/j.surg.2010.01.008

    Article  Google Scholar 

  53. Eriksen JR, G\ogenur I, Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11:481–492. doi:10.1007/s10029-007-0282-8

    Article  CAS  PubMed  Google Scholar 

  54. Albino FP, Patel KM, Nahabedian MY, Sosin M, Attinger CE, Bhanot P (2013) Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg 132:1295–1304. doi:10.1097/PRS.0b013e3182a4c393

    Article  CAS  PubMed  Google Scholar 

  55. Guèrin G, Turquier F (2013) Impact of the defect size, the mesh overlap and the fixation depth on ventral hernia repairs: a combined experimental and numerical approach. Hernia 17:647–655. doi:10.1007/s10029-013-1050-6

    Article  PubMed  Google Scholar 

  56. Fortelny RH, Petter-Puchner AH, Glaser KS, Redl H (2012) Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review. Surg Endosc 26:1803–1812. doi:10.1007/s00464-012-2156-0

    Article  PubMed  Google Scholar 

  57. Brill JB, Turner PL (2011) Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 77:458–465

    PubMed  Google Scholar 

  58. Zeichen MS, Lujan HJ, Mata WN, Maciel VH, Lee D, Jorge I, Plasencia G, Gomez E, Hernandez AM (2013) Closure versus non-closure of hernia defect during laparoscopic ventral hernia repair with mesh. Hernia 17:589–596. doi:10.1007/s10029-013-1115-6

    Article  CAS  PubMed  Google Scholar 

  59. Rea R, Falco P, Izzo D, Leongito M, Amato B (2012) Laparocopic ventral hernia repair with primary transparietal closure of the hernial defect. BMC Surg 12(Suppl 1):S33. doi:10.1186/1471-2482-12-S1-S33

    Article  PubMed Central  PubMed  Google Scholar 

  60. Tse GH, Stutchfield BM, Duckworth AD, De Beaux AC, Tulloh B (2010) Pseudo-recurrence following laparoscopic ventral and incisional hernia repair. Hernia 14:583–587

    Article  CAS  PubMed  Google Scholar 

  61. Liang MK, Subramanian A, Awad SS (2012) Laparoscopic transcutaneous closure of central defects in laparoscopic incisional hernia repair. Surg Laparosc Endosc Percutan Tech 22:e66–e70. doi:10.1097/SLE.0b013e3182471fd2

    Article  PubMed  Google Scholar 

  62. Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Trans-cutaneous Closure of Central Defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37:42–51. doi:10.1007/s00268-012-1810-y

    Article  PubMed  Google Scholar 

  63. Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 20:71–75. doi:10.1007/s00464-005-0091-z

    Article  CAS  PubMed  Google Scholar 

  64. Mussack T, Ladurner R, Vogel T, Lienemann A, Eder-Willwohl A, Hallfeldt KK (2006) Health-related quality-of-life changes after laparoscopic and open incisional hernia repair: a matched pair analysis. Surg Endosc 20:410–413. doi:10.1007/s00464-005-0440-y

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Center for Clinical and Translational Sciences, which is funded by the National Institutes of Health Clinical and Translational Award UL1 TR000371 and KL2 TR000370 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

Disclosures

Author Mike Liang discloses a KL2 TR000370 from the National Institutes of Health.

Authors Nestor A. Arita, Mylan T. Nguyen, Duyen H. Nguyen, Rachel L. Berger, Debbie F. Lew, James T. Suliburk, Erik P. Askenasy, and Lillian S. Kao have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General Surgery, Baylor College of Medicine, Houston, TX, USA

    Nestor A. Arita, Rachel L. Berger, James T. Suliburk & Erik P. Askenasy

  2. Department of General Surgery, University of Texas Health Science Center at Houston, 5656 Kelley Street, Houston, TX, 77026, USA

    Mylan T. Nguyen, Duyen H. Nguyen, Debbie F. Lew, Lillian S. Kao & Mike K. Liang

Authors
  1. Nestor A. Arita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mylan T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Duyen H. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel L. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Debbie F. Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James T. Suliburk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erik P. Askenasy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lillian S. Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mike K. Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mike K. Liang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arita, N.A., Nguyen, M.T., Nguyen, D.H. et al. Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias. Surg Endosc 29, 1769–1780 (2015). https://doi.org/10.1007/s00464-014-3859-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3859-1

Keywords

Search

Navigation