Laparoscopic IH repair tied to lower infection risk vs open repair

Elective laparoscopic incisional hernia (IH) repair appears as effective as open repair and potentially more beneficial in reducing postoperative infection rates and blood loss, according to a Singapore study.

“Given the associations with lower intraoperative blood loss, lower postoperative infection rates, and comparable recurrence rates with the literature … laparoscopic IH repair is a promising alternative to open repair in an elective setting,” the researchers said.

This retrospective study was carried out in an acute general hospital in Singapore between 2010 and 2015 to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population. Patients who had IH repair in an elective setting, IHs with diameter of 3‒15 cm, and IH located at the ventral abdominal wall were eligible for inclusion.

The researchers excluded those who underwent emergency repair, had recurrent hernias, or had loss of abdominal wall domain (ie, hernia sac containing >30 percent of abdominal contents or any solid organs). They then compared 1-year postoperative outcomes such as pain, infection, recurrence, haematoma, and seroma formation between the two cohorts.

A total of 174 patients met the eligibility criteria, majority of which were older Chinese women who were overweight. Of the patients, 50.6 percent underwent laparoscopic repair and 49.4 percent open repair. The mean operation time was 139 minutes for laparoscopic repair and 116 minutes for open repair (p=0.079). [Singapore Med J 2023;64:105-108]

Postoperative wound infection occurred in 15.1 percent of patients in the open repair group compared with only 1.1 percent in the laparoscopic group (p=0.0007) within a year following the procedure. On the other hand, no significant differences were seen in postoperative pain, recurrence, and haematoma or seroma formation.

Postoperative outcomes

“Laparoscopic IH repair was found to be associated with lower rates of postoperative infection in terms of both superficial as well as deep infections,” the researchers said.

Infections in prosthetic mesh repairs could result in disastrous outcomes, which might require explantation or mesh salvage and long-term antibiotic treatment. Specifically, explantation may result in weakness that puts patients at risk of hernia recurrence. In addition, long-term antibiotics use comes with several adverse effects. [Surg Infect (Larchmt) 2011;12:205-210]

“In our study, all three patients with deep infections required readmission for explantation of mesh, drainage of intra-abdominal collections, and antibiotics,” the researchers said. “On the other hand, the laparoscopic group only had one patient with superficial surgical site infection, which resolved with oral antibiotics.”

In terms of IH recurrence, the rates were 10.5 percent and 11.4 percent in the open and laparoscopic groups, respectively, which were similar to those reported in the literature. [BMC Surg 2009;9:6; JAMA 2016;316:1575-1582]

The first case of laparoscopic IH repair was described in 1993 by LeBlanc and Booth, and since then its benefits, such as lower postoperative pain, effectiveness, and safety, had been observed. It has also become the gold standard for appendicectomies and cholecystectomies in the past decades. [Surg Laparosc Endosc 1993;3:39-41; J Am Coll Surg 2000;190:645-650]