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Endoscopic component separation for laparoscopic and open ventral hernia repair: a single institutional comparison of outcomes and review of the technique
Authors:S C Azoury  A P Dhanasopon  X Hui  S H Tuffaha  C De La Cruz  C Liao  M Lovins  H T Nguyen
Institution:1. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA
8. Department of Surgery, Johns Hopkins University, School of Medicine, 600?N. Wolfe Street, Blalock 658, Baltimore, MD, 21287, USA
2. Center for Surgical Trials and Outcomes Research (CSTOR), The Johns Hopkins Hospital, Baltimore, MD, 21287, USA
3. Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA
4. Johns Hopkins University, School of Medicine, Baltimore, MD, 21287, USA
5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
6. Johns Hopkins Comprehensive Hernia Center, Baltimore, MD, 21287, USA
7. Department of Biomedical Engineering, Center for Bioengineering Innovation and Design, Johns Hopkins University, Baltimore, MD, 21287, USA
Abstract:

Purpose

To our knowledge, there are limited small case series reports on endoscopic component separation (ECS) and no single institutional study comparing the difference in outcomes between laparoscopic and open ventral hernia repairs following endoscopic component separation.

Methods

A single institutional retrospective review was performed, identifying 42 patients who underwent endoscopic component separation at a single institution by a single surgeon for ventral hernia repair with prosthesis from 2010 to 2013. Seventeen patients underwent subsequent open ventral hernia repair (OHR) and 25 underwent laparoscopic ventral hernia repair (LHR). Demographics, surgical factors, wound complications and hernia occurrence post-operatively were reviewed.

Results

Surgical factors/demographics were similar between groups. All patients achieved primary fascial and skin closure. Operative time for the laparoscopic group was significantly shorter than the open group (278 vs. 378 min; P = 0.0001), and there was a trend towards a shorter hospital stay in the laparoscopic group (laparoscopic, 4 days; open, 5 days; P = 0.063). Estimated blood loss per case with ECS and subsequent laparoscopy was significantly lower than in the open cases (63 vs. 147 cc; P = 0.0017). In both groups, wound complications occurred in five patients (laparoscopic, 20 %; open, 29 %; P = 0.71). There was one midline hernia recurrence and two lateral abdominal wall hernia occurrences post-operatively in the laparoscopic group, whereas there were no midline and one lateral wall hernia occurrence in the open group.

Conclusions

Patients undergoing endoscopic component separation with subsequent laparoscopic fascial reapproximation had a significantly shorter operative time and estimated blood loss when compared with open fascial reapproximation. Wound complications were similar in both groups although there were a greater number of hernia occurrences post-operatively in the laparoscopic group, though of no statistical significance.
Keywords:
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