Laparoscopic ventral hernia repair in the elderly: does the type of hernia matter?

Abstract

Purpose: Assess the impact of age and type of hernia on the outcomes of laparoscopic ventral hernia repair (LVHR).

Methods: Operating room database of all laparoscopic ventral hernias performed from April 2001 to July 2010 was analyzed retrospectively. Patients were divided into two groups: primary hernias (Group 1) and incisional hernias (Group 2). These groups were further stratified into patients <65 years of age (Groups 1A and 2A) and patients >65 years of age (Groups 1B and 2B). Patient demographics, hernia characteristics, perioperative outcomes, and disposition at discharge were compared. p-values <0.05 were considered significant.

Results: 325 patients, with a mean age of 56.6 years (24-93 years) underwent LVHR. The mean length of stay (LOS) was longer (2.7 days vs 1.7 days, p value = 0.02), and the rate of same day discharge was also significantly lower (12 vs. 25 %, p = 0.02) for Group 2B when compared to Group 2A. Three patients in Group 2B, who had been living independently, were discharged to a skilled nursing facility, which proved significantly different when compared with Group 2A. There was no statistically significant difference in perioperative outcomes between younger and older subgroups with primary hernias.

Conclusions: LVHR in the elderly with incisional hernias have longer LOS and have a higher need for post-discharge nursing care unlike their counterparts with primary hernias. Identifying this cohort of patients early on helps the health-care providers to optimize the outcomes.