Illustration comparing laparoscopic and open surgery for ventral hernia repair, highlighting the benefits of minimally invasive techniques.

Laparoscopic vs. Open Hernia Repair: Which is Best for Obese Patients?

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A new study reveals the pros and cons of each surgical approach for ventral hernia repair in obese individuals, focusing on recovery time and costs."

Obesity is a widespread health concern, and its association with ventral hernias is well-documented. Recent research suggests that laparoscopic ventral hernia repair (LVHR) may offer advantages for obese patients compared to traditional open surgery. This analysis delves into a study comparing length of stay, hospitalization costs, and operative time for both LVHR and open ventral hernia repair.

The original study retrospectively examined obese patients (BMI > 30kg/m²) who underwent ventral hernia repair between 2014 and 2015. Researchers compared demographics, hernia size, operative time (OT), length of stay (LOS), and hospitalization costs (HC) between the two surgical methods.

Out of 100 patients with ventral hernia repair, 11% underwent the laparoscopic approach. Laparoscopy was selectively used for elective surgeries and smaller defects. While operative times were similar between the two groups, the length of stay was significantly shorter with laparoscopy (2.9 days vs. 8.53 days). However, hospitalization costs were higher for laparoscopic repair.

Laparoscopic Ventral Hernia Repair: Weighing the Benefits and Drawbacks

Illustration comparing laparoscopic and open surgery for ventral hernia repair, highlighting the benefits of minimally invasive techniques.

The study included 100 obese patients who underwent ventral hernia repair at Emergency County Hospital Constanta and Ovidius Clinical Hospital between January 2014 and December 2015. All patients had a BMI greater than 30kg/m². Data collected included age, sex, BMI, type and location of hernia, size of defect, surgery duration, length of hospital stay, and costs.

The laparoscopic approach involved creating a pneumoperitoneum using a Veress needle or open technique. A 10mm trocar was placed for a 30° laparoscope, with additional trocars inserted under direct vision. Hernia contents were reduced, and the parietal defect inspected. A composite mesh was placed intra-abdominally, overlapping the defect by at least 3cm in all directions, secured with non-absorbable sutures and tacks.

Shorter Hospital Stays: One of the most compelling advantages of laparoscopic repair is the reduced length of hospital stay. Patients undergoing LVHR in the study experienced an average stay of 2.9 days, compared to 8.53 days for open surgery.
Comparable Operation Times: Despite being minimally invasive, the operative time for laparoscopic repair was almost identical to open surgery (approximately 119 minutes). This suggests that surgeons can achieve similar results in terms of repair duration.
Higher Hospitalization Costs: The study revealed that the cost associated with laparoscopic repair was higher compared to open surgery. This difference is primarily attributed to the use of specialized materials such as composite mesh and endotackers, which are essential for the laparoscopic technique.

The results indicated that while laparoscopic repair offers a significantly shorter hospital stay, it comes with higher hospitalization costs. The study highlights the importance of considering both clinical outcomes and economic factors when choosing between laparoscopic and open approaches for ventral hernia repair in obese patients.

Making the Right Choice for Your Health

Deciding between laparoscopic and open ventral hernia repair involves carefully weighing the benefits and drawbacks of each approach, especially when obesity is a factor. While laparoscopy offers the advantage of a quicker recovery and shorter hospital stay, the higher costs associated with the procedure should be taken into consideration. Ultimately, the best choice depends on individual circumstances, the size and complexity of the hernia, and a thorough discussion with your surgeon to determine the most appropriate and cost-effective option for your specific needs.

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Everything You Need To Know

For obese patients needing ventral hernia repair, what are the main differences between the laparoscopic and open surgical approaches?

The primary differences between Laparoscopic Ventral Hernia Repair (LVHR) and open ventral hernia repair for obese patients involve recovery time and costs. LVHR generally leads to a shorter length of stay in the hospital (2.9 days on average) compared to open surgery (8.53 days). However, LVHR typically has higher hospitalization costs due to the specialized materials used, like composite mesh and endotackers. Both approaches have comparable operative times (around 119 minutes).

Why might a surgeon choose the laparoscopic approach (LVHR) for an obese patient with a ventral hernia?

Surgeons might favor Laparoscopic Ventral Hernia Repair (LVHR) for obese patients due to its potential for a quicker recovery and shorter hospital stay. The study data indicates a significant reduction in the length of stay for patients undergoing LVHR (2.9 days) compared to open surgery (8.53 days). LVHR is also selectively used for elective surgeries and smaller defects. While operative times are similar, the reduced hospital stay can be a significant benefit, although this comes with higher hospitalization costs.

What are the financial implications when choosing between laparoscopic and open ventral hernia repair?

The financial implications are that Laparoscopic Ventral Hernia Repair (LVHR) generally incurs higher hospitalization costs compared to open ventral hernia repair. This is mainly due to the use of specialized materials such as composite mesh and endotackers, which are essential for the laparoscopic technique. While the length of stay is shorter with LVHR, the initial cost of the procedure is higher. Therefore, when deciding between the two approaches, patients and surgeons need to consider whether the benefits of a shorter hospital stay justify the increased expense.

How was the effectiveness of laparoscopic ventral hernia repair (LVHR) and open surgery evaluated in the study?

The study retrospectively examined obese patients (BMI > 30kg/m²) who underwent ventral hernia repair between 2014 and 2015 at Emergency County Hospital Constanta and Ovidius Clinical Hospital. The researchers compared demographics, hernia size, operative time (OT), length of stay (LOS), and hospitalization costs (HC) between the two surgical methods. This direct comparison allowed them to assess the clinical and economic differences between Laparoscopic Ventral Hernia Repair and open ventral hernia repair in the context of obese patients.

Besides length of stay and cost, are there other factors obese patients should discuss with their surgeon when considering ventral hernia repair?

Yes, beyond the length of stay and costs, obese patients should discuss several other factors with their surgeon. These include the size and complexity of the hernia, as laparoscopy was selectively used for smaller defects. The patient's overall health, specific needs, and preferences should be considered. A comprehensive discussion ensures that the chosen approach aligns with the patient's individual circumstances and maximizes the potential for a successful outcome, as the 'best choice depends on individual circumstances' and a 'thorough discussion with your surgeon'.