Incisional hernia laparoscopic repair reduces length of stay

Incisional hernia: laparoscopic repair reduces length of stay A Maconie, M Hussainy, HS Khaira

Introduction • After 10 -20% of laparotomies • 75% occur within 3 years of surgery

Introduction Open technique Recurrence (%) Primary suture closure 39 Underlay (intraperitoneal) mesh 4. 5 Underlay (extraperitoneal) mesh 8 Onlay mesh 14 Inlay mesh 48 Rudmik et al Hernia 2006

Introduction Laparoscopic repair • Inspection of whole wound (‘Swiss cheese’) • Fewer wound complications • Enterotomy (2%) • Quicker recovery • Recurrence 4. 4%

Methods • • • Retrospective audit Single surgeon’s experience (logbook) 3 years Laparoscopic and open repairs Computerised theatre data and EPR

Results Lap (67) Open (18) Mean age (years) M: F Mean operating time (min) 60. 5 59. 8 35: 32 8: 10 76 80

Results – lap group 100 90 80 70 60 50 40 30 20 10 0 Mean Operation Time (mins) Cohort 1 Cohort 2 Cohort 3 Cohort 4

Results – LOS (days) Open Laparoscopic Median 2 1 Mean 3. 8 1. 4 Range 0 -20 0 -8

Complications (%) Wound infection Haemo-seroma Medical Chronic pain Persistent bulge Laparoscopic 6 10 10 7 4 Open 6 18 6 -

Discussion • • • Limitations of retrospective audit Small numbers Similar complication rates Shorter hospital stay 23 hour facility

Discussion

Conclusion • Laparoscopic incisional hernia repair shortens length of stay • Better post-op analgesia (e. g. TAP block) • 23 hour facility

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