A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching.

PURPOSE: Patients with liver cirrhosis may require inguinal hernia repair. It is unknown if surgical approach, laparoscopic or open, affects outcomes in this high-risk patient population. This study compares complications, deaths, and length of stay between open and laparoscopic inguinal hernias in patients with liver disease.

METHODS: All patients (N = 145,780) who were diagnosed with inguinal hernia (ICD-9-codes: 550.00, 550.02, 550.10, 550.12, 550.90, and 550.92) and had unilateral repair surgery (current procedure codes: 49505, 49507, 49525, and 49650) between 2005 and 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Data collected included patient demographics, comorbid conditions, postsurgical diagnosis, and outcomes. Multivariate logistic regression models were employed to evaluate the associations between various outcomes and surgical approach.

RESULTS: The percentage of open inguinal hernia repair (OIHR) decreased from 84.08% in 2005 to 74.66% in 2014. The mean MELD score was 9.09 ± 4.02 among open surgery patient group, which was higher than the mean MELD score (8.03 ± 2.78) among laparoscopic surgery group. After propensity score matching for patient characteristics, open and laparoscopic inguinal hernia groups had similar length of stay with a slightly longer operation time being observed among laparoscopic group. Overall complications rates were similar (OR 0.87, 95% CI 0.-1.15, p = 0.32) as was overall mortality (0.27% among open surgery patients and 0.12% among laparoscopic patients, OR 0.42, 95% CI 0.15-1.21, p = 0.96).

CONCLUSION: Laparoscopic inguinal hernia repair demonstrates similar morbidity and mortality when compared to open repairs in patients with liver disease suggesting that both are viable repair options.