Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study

• Published in: Surgical endoscopy Vol. 24; no. 8; pp. 1872 - 1877
• Main Authors: Jenkins, Eric D., Yom, Victoria H., Melman, Lora, Pierce, Richard A., Schuessler, Richard B., Frisella, Margaret M., Christopher Eagon, J., Michael Brunt, L., Matthews, Brent D.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-08-2010; Springer; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Biological and medical sciences; Bladder; Body mass index; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology; Gynecology; Hepatology; Hernia, Ventral - surgery; Hernias; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - adverse effects; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Patients; Peritonitis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Care; Proctology; Prospective Studies; Risk Factors; Surgery; Sutures; Time Factors; Prospective; Hernia repair; Complication; Laparoscopy; Suprapubic; Complexity; Hernia; Endoscopic surgery; Treatment; Endoscopy; Predictive factor; Repair
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-009-0863-y

Background
Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative setting predictive of longer operative times and complexity in laparoscopic ventral hernia repair.
Methods
Patient demographics including body mass index (BMI), comorbidities, previous laparoscopic and open surgical procedures, ventral hernia repairs, and hernia characteristics (defect size and location, adhesions, incarceration) were recorded prospectively. Data are given as mean ± standard deviation. Times (min) required for abdominal access, adhesiolysis, and mesh placement as well as the total operative time were recorded during each case as outcome measures of operative difficulty. Univariate analyses were performed with the
t
-test or the Mann–Whitney
U
test as well as multivariate analyses using the stepwise analysis of covariance model to determine demographic and clinical variables influencing operative times.
Result
The study enrolled 180 patients (78 men and 102 women) with a mean age of 54.8 ± 12.2 years and a mean BMI of 33.3 ± 13.0 kg/m
2
. Multivariate analysis demonstrated significantly longer (
p
 < 0.05) adhesiolysis and total operative times for patients with prior ventral hernia repairs, suprapubic hernia, bowel adhesion to the abdominal wall or hernia sac, and larger hernia defect. The total operative time also was increased (
p
 < 0.05) with incarcerated hernia contents. Mesh placement time was increased (
p
 < 0.05) with incarcerated hernia contents, suprapubic hernia location, hernias requiring larger mesh for repair, and decreased postgraduate year of the surgical assistant. The time required to obtain abdominal access was longer (
p
 < 0.05) with a greater BMI and a higher American Society of Anesthesiology (ASA) classification. The operative times were not increased with a history of peritonitis, diabetes, immunosuppression, cancer, or with higher numbers of previous open or laparoscopic surgeries.
Conclusions
At least 10 preoperatively identifiable patient variables, either alone or in combination, are predictive of prolonged operative times during laparoscopic ventral hernia repair and may be used as surrogates to determine the complexity of a minimally invasive approach.