Singapore Medical Journal · 5 authors, 1 centre
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This retrospective study of 174 patients in Singapore found that laparoscopic elective incisional hernia repair resulted in significantly fewer postoperative wound infections (1.1%) compared to open repair (15.1%), with comparable rates of recurrence, pain, and seroma formation. Laparoscopic repair also had significantly lower intraoperative blood loss. The findings suggest laparoscopic repair is a safe alternative that may reduce infectious complications in an Asian population.
**Background:** Incisional hernias (IHs) occur in 7.4%–60.0% of patients after surgery, with 50% detected within one year. Laparoscopic repair has emerged as a promising alternative to open repair, but evidence has been largely from Caucasian populations. This study aimed to compare postoperative outcomes between laparoscopic and open elective IH repair in an Asian cohort.
**Methods:** A retrospective study was conducted at Tan Tock Seng Hospital, Singapore, including patients who underwent IH repair from 2010–2015. Inclusion criteria: elective repair, IH diameter 3–15 cm, ventral abdominal wall location. Exclusion criteria: emergency repair, recurrent hernias, loss of abdominal wall domain (>30% abdominal contents or solid organs in sac). All patients had preoperative cross-sectional imaging. Open repair used mesh placed via onlay (45%), sublay (40%), underlay (12%), or inlay (3%) methods. Laparoscopic repair used 3–4 trocars, adhesiolysis, and mesh anchored with circumferential tacks with 3–5 cm overlap. All patients received preoperative antibiotics. Data were analyzed using SPSS v21.0; chi-square, Mann-Whitney U, and multivariate analyses were performed; P<0.05 was significant.
**Key Results:** 174 patients were included: 86 (49.4%) open, 88 (50.6%) laparoscopic. Six laparoscopic cases were converted to open due to dense adhesions. Mean age was 62.5±13.5 years (open) vs 61.5±13.1 years (laparoscopic) (P=0.545); 70.9% vs 75.0% female (P=0.465); mean BMI 27.1±5.1 vs 28.1±5.7 kg/m² (P=0.588). Comorbidities and ASA status were similar between groups. The most common presenting complaint was an asymptomatic lump (87.2% open vs 96.6% laparoscopic, P=0.003); pain was more common in the open group (9.3% vs 2.3%, P=0.030). Mean operation time was 116±61 min (open) vs 139±65 min (laparoscopic) (P=0.079). Mean hernia defect size was 61.6 cm² (IQR 25–100) vs 60.0 cm² (IQR 23–110) (P=0.576). Blood loss was significantly lower in the laparoscopic group: 10 mL (IQR 10–100) vs 50 mL (IQR 10–150) (P=0.030). Postoperative wound infection occurred in 15.1% (n=13) of open repairs vs 1.1% (n=1) of laparoscopic repairs (P=0.0007). In the open group, 10 had superficial infections and 3 had deep infections (enterocutaneous fistula, intra-abdominal abscesses requiring mesh explantation); no deep infections occurred in the laparoscopic group. Postoperative pain (6.8% vs 2.3%, P=0.148), haematoma/seroma (2.3% vs 4.5%, P=0.418), and recurrence (10.5% vs 11.4%, P=0.531) were not significantly different.
**Clinical Implications:** Laparoscopic elective IH repair offers significantly lower postoperative wound infection rates and reduced intraoperative blood loss compared to open repair, with comparable recurrence, pain, and seroma rates. This is particularly relevant given that mesh infections can be catastrophic, often requiring explantation and long-term antibiotics. The study extends evidence to an Asian population, where prior data were lacking. Limitations include retrospective design, possible selection bias, lack of standardized surgical technique, short one-year follow-up, and single-institution small sample size. Future multicenter studies with longer follow-up are needed.