Patient selection criteria for an effective laparoscopic intraperitoneal ventral hernia repair in day surgery

The laparoscopic treatment of abdominal wall defects is currently a valid alternative to the open technique, given the possibility to significantly reduce the length of hospital stay and, consequently, to allow its carrying out in a day surgery setting. The comparison between the two methods has also been the subject of a Cochrane meta-analysis performed by Sauerland et al. (Cochrane Database Syst Rev 3: CD007781, 2011), which pointed out how, in spite of many clinical trials indicating the superiority of laparoscopy in terms of invasiveness and postoperative pain control, the quality of evidence is low due to the excessive variability among the different series in terms of reported complications. Moreover, what should be the selection criteria of patients fit for laparoscopic treatment in day surgery is not yet defined. This retrospective study considered 94 patients with primary or recurrent incisional wall hernias treated with laparoscopic technique over a 7-year period of time, from 2011 to 2018. The aim was to define the selection criteria for an effective day surgery laparoscopic treatment, considering as outcome the rate of conversion to ordinary hospitalization (discharge > POD1). Discharge > POD 1 was necessary in 15 cases out of 94 (16%). Concerning this outcome, statistically significant risk factors were ASA score > I (p = 0.022), number of hernia orifices > 1 (p = 0.001), recurrent hernias (p = 0.002) and hernia diameter > 10 cm (p < 0.0001). These factors were confirmed by univariate binary logistic analysis. A stepwise model of multivariate analysis showed as determinants for adverse events ASA score > 1 (OR 5.2, 95% CI 1.1-25.6, p = 0.043) and hernias > 10 cm (OR 7.0, 95% CI 1.1-46.4, p = 0.045). This work highlighted some useful criteria for preoperative selection of patients fit for laparoscopic abdominal wall defects repair in a day surgery setting. In particular, criteria related to a favorable clinical outcome were ASA score < II and a hernia diameter < 10 cm.