PMID- 23153398
OWN - NLM
STAT- MEDLINE
DCOM- 20130308
LR  - 20141120
IS  - 1879-1883 (Electronic)
IS  - 0002-9610 (Linking)
VI  - 205
IP  - 2
DP  - 2013 Feb
TI  - Laparoscopic umbilical hernia repair is the preferred approach in obese patients.
PG  - 231-6
LID - S0002-9610(12)00436-9 [pii]
LID - 10.1016/j.amjsurg.2012.02.022 [doi]
AB  - INTRODUCTION: The optimal method of umbilical hernia repair (UHR) in the obese 
      population, laparoscopic vs open, is not standardized. The purpose of this study 
      was to determine the optimal surgical option for UHR in the obese population. 
      METHODS: A retrospective chart review was conducted on 123 obese patients (body 
      mass index [BMI] >30) who underwent UHR from 2003 to 2009 at a single 
      institution. Patients were grouped by surgical approach (open vs laparoscopic). 
      Intraoperative and postoperative courses were compared. Follow-up in the 
      postoperative period was obtained from patient records and telephone interviews. 
      RESULTS: Of the 123 patients undergoing UHR, 40 and 83 patients were operated on 
      with the laparoscopic and open approach, respectively. Patients were well matched 
      by demographics as well as comorbidities. No difference in the mean BMI was shown 
      between the laparoscopic and open groups (37 vs 35, P = not significant, 
      respectively). The operative time was significantly prolonged in the laparoscopic 
      group (106 vs 71 minutes, P < .01). Intraoperatively, no complications occurred 
      in either group. In the immediate postoperative period, 1 patient who underwent 
      laparoscopic UHR was readmitted for small bowel obstruction, and 2 patients in 
      the open group were readmitted, 1 for pain control and 1 for wound infection. 
      Follow-up was achieved in 63% of the laparoscopic group and 58% of the open group 
      with a mean follow-up of 15 months in the laparoscopic group and 20 months in the 
      open group (P = not significant). A significant increase in wound infection was 
      reported in the open group with mesh insertion when compared with the 
      laparoscopic procedure (26% vs 4%, P < .05, respectively). No hernia recurrence 
      was shown in the laparoscopic vs the open group with mesh insertion (0% vs 4%, P 
      = not significant, respectively). CONCLUSIONS: In obese patients, the 
      laparoscopic approach was associated with a significantly lower rate of 
      postoperative infection and no hernia recurrence. Laparoscopic hernia repair may 
      be the preferred option in the obese patient.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Colon, Modesto J
AU  - Colon MJ
AD  - Department of Surgery, Division of General Surgery, The Mount Sinai Hospital, New 
      York, NY, USA.
FAU - Kitamura, Riley
AU  - Kitamura R
FAU - Telem, Dana A
AU  - Telem DA
FAU - Nguyen, Scott
AU  - Nguyen S
FAU - Divino, Celia M
AU  - Divino CM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20121113
PL  - United States
TA  - Am J Surg
JT  - American journal of surgery
JID - 0370473
SB  - IM
MH  - Body Mass Index
MH  - Comorbidity
MH  - Elective Surgical Procedures
MH  - Emergency Treatment/methods
MH  - Female
MH  - Hernia, Umbilical/complications/*surgery
MH  - Herniorrhaphy/*methods
MH  - Humans
MH  - *Laparoscopy
MH  - Male
MH  - Medical Records
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Operative Time
MH  - Research Design
MH  - Retrospective Studies
EDAT- 2012/11/17 06:00
MHDA- 2013/03/09 06:00
CRDT- 2012/11/17 06:00
PHST- 2011/04/23 00:00 [received]
PHST- 2012/01/06 00:00 [revised]
PHST- 2012/02/01 00:00 [accepted]
PHST- 2012/11/17 06:00 [entrez]
PHST- 2012/11/17 06:00 [pubmed]
PHST- 2013/03/09 06:00 [medline]
AID - S0002-9610(12)00436-9 [pii]
AID - 10.1016/j.amjsurg.2012.02.022 [doi]
PST - ppublish
SO  - Am J Surg. 2013 Feb;205(2):231-6. doi: 10.1016/j.amjsurg.2012.02.022. Epub 2012 
      Nov 13.