Multicenter analysis of laparoscopic versus open umbilical hernia repair with mesh: outcomes and quality of life (QoL).

INTRODUCTION: Umbilical hernia repair (UHR) is a common operation with varying surgical approaches. Laparoscopic (LUHR) and open (OUHR) operations are routinely performed, but their impact on quality of life (QoL) is not well described. Our aim was to evaluate perioperative outcomes and QoL of LUHR versus OUHR. METHODS: The prospectively collected International Hernia Mesh Registry was queried for patients undergoing UHR with mesh placement. QoL was measured using the Carolinas Comfort Scale preoperatively and 1, 6, 12, and 24 months postoperatively. Propensity match was performed controlling for hernia defect size (HDS), recurrent hernias, and BMI. RESULTS: 585 patients underwent 178 (30.4%) LUHR and 407 (69.6%) OUHR. LUHR patients had higher BMI, larger HDS, and more recurrent hernias (p < 0.05). Rates of other comorbidities were similar (p > 0.05). Tacks were used more frequently in LUHR (91.6% vs 1.7%, p < 0.001), and suture was used more often in OUHR (97.1% vs 47.8%, p < 0.001). Postoperative outcomes were similar (p > 0.05) except LUHR had higher rates of seroma (13.9% vs 4.3%, p < 0.001). Overall recurrence rates trended to favor OUHR, but not significantly (4.7% vs 8.4%, p = 0.07). The propensity match yielded 138 matched pairs. LUHR had more seromas and OUHR had higher infection rates (p < 0.05). Hernia recurrence was higher following LUHR (9.4% vs 2.9%, p = 0.02). QoL data were available for an average of 457 patients at each time period. QoL was superior in the OUHR group for pain and overall QoL at each time point and activity limitations at 6 and 12 months (p < 0.05). When examining patients who were asymptomatic preoperatively, OUHR had improved one-month overall QoL, but both groups had over 90% of patients report being asymptomatic postoperatively. CONCLUSIONS: OUHR is associated with higher rates of surgical site infections, but significantly lower rates of seroma formation and hernia recurrence compared to LUHR, while having superior QoL in both short- and long-term follow-up. Asymptomatic patients tend to have excellent QoL outcomes.

Is There Any Role for Direct Repair of Extensor Mechanism Disruption Following Total Knee Arthroplasty?

BACKGROUND: Extensor mechanism disruption remains a challenging problem in total knee arthroplasty (TKA) with historically poor outcomes. The purpose of our study is to determine if patients undergoing acute extensor mechanism repair had different outcomes than patients undergoing allograft reconstruction. METHODS: We reviewed a series of 126 total knee arthroplasty patients requiring surgical repair or reconstruction of an extensor mechanism injury from 2005 to 2014 with a minimum of 24 months of follow-up. Demographics, comorbidities, Knee Society Scores, time from injury, and reoperations were all recorded from the medical record. A poor outcome was defined as an extensor lag >30°, postoperative Knee Society Scores <60, or a reoperation. A multivariate analysis was then performed to identify independent risk factors for a poor outcome. RESULTS: Of the 126 patients, there were 58 patients who underwent direct extensor repair (46%) and 68 patients who underwent allograft reconstruction (54%) at a mean postsurgical follow-up of 81.2 months. Rates of poor outcomes were comparably high in both groups (33% vs 44%, P = .192). Patella tendon repair had the highest rate of poor outcomes compared to quadriceps repair and patella fixation (63% vs 22% vs 8%, P = .002). Independent risk factors for poor outcomes included patients with a history of infection (odds ratio 4.559, P = .002) and injury greater than 2 weeks duration (odds ratio 4.237, P = .031). CONCLUSION: Outcomes following direct extensor mechanism are comparable to extensor mechanism allograft reconstruction; however, patients should be counseled regarding poor outcomes. Direct repair of patellar tendon injuries should likely be avoided due to prohibitively high complication rate.