Laparoscopic versus open incisional hernia repair An open randomized controlled study S. Olmi, A. Scaini, G. C. Cesana, L. Erba, E. Croce Department of Surgery, Center of Laparoscopic and Minimally Invasive Surgery, S. Gerardo Hospital, via Donizetti 106, 20052 Monza, Milan, Italy Received: 29 September 2006/Accepted: 7 October 2006/Online publication: 16 February 2007 Abstract Background: Incisional hernia is a common complica- tion of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case- control study to compare laparoscopic versus anterior- open incisional hernia repair. Methods: 170 patients with incisional hernia were en- rolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparo- scopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. Results: No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6–15 days) in LG patients and 25 days (range, 16–30 days) in OG patients. Complica- tions occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. Conclusions: Short-term results indicate that laparo- scopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster re- turn to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings. Key words: Incisional hernia — Laparoscopy — Lap- aroscopic incisional hernia — Composite mesh An incisional hernia is a bulge or protrusion that occurs near or directly along a prior abdominal surgical inci- sion, and it often requires support and repair [16]. It represents a common problem in general surgeonsÕ practice, and it is often a source of complications and prolonged hospitalization. Incisional hernias occur in up to 11% of surgical abdominal wounds and in up to 20% of patients that develop a postoperative wound infection [6, 20]. Incisional hernia can be repaired by an anterior ap- proach, through direct sutures or mesh placement, or by a laparoscopic transperitoneal approach, applying a mesh that can overlap the weakened area. Although there are data suggesting that laparoscopic repair leads to a lower rate of complications and relapses and to a shorter hospitalization compared to open surgery [7, 13, 21], randomized controlled trials with long-term follow- up are lacking, and it is still debated which of the two approaches is the better treatment [9, 12]. The aim of this study was to compare laparoscopic with anterior-open incisional hernia repair, done in the same institution by the same team, which had wide experience in both open and laparoscopic surgery. An analysis of direct costs and Italian National Health System reimbursement is also provided (Table 4). Materials and methods Patient characteristics Patients with incisional hernia who met eligibility criteria for surgical procedures were enrolled in this study between September 2001 and December 2004. The inclusion criteria were performance status according to a Karnofsky score 80%–100%, indication and eligibility for a surgical procedure with curative intent, and clinical confirmed incisional hernia. Exclusion criteria were cardiopulmonary disorders, portal hypertension, contraindications to laparoscopic procedures, and an American Society of Anesthesiologists (ASA) score = 5. Patients were randomized in two groups: one group underwent laparoscopic incisional hernia repair (n = 85; LG); the other underwent open sur- Correspondence to: S. Olmi Surg Endosc (2007) 21: 555–559 DOI: 10.1007/s00464-007-9229-5 Ó Springer Science+Business Media, Inc. 2007