Laparoscopic versus open emergency repair for strangulated abdominal wall hernias: a propensity-score-matched retrospective cohort study.

BACKGROUND AND OBJECTIVES: The optimal surgical approach for incarcerated or strangulated abdominal wall hernias remains debated. While laparoscopic techniques are well established electively, evidence on their emergency-setting role is limited. This study compared open and laparoscopic repair in patients undergoing emergency surgery for incarcerated or strangulated abdominal wall hernias, focusing on postoperative morbidity, mortality, operative time, and hospital stay. MATERIALS AND METHODS: This retrospective single-center cohort study included 180 consecutive patients treated between January 2023 and June 2025, analyzed by initially intended approach (open, n = 90; laparoscopic, n = 90; converted patients retained in their original group). Demographics, hernia type, intraoperative findings, complications, mortality, and length of stay were compared using Fisher's exact and Mann-Whitney U tests. Wound-related morbidity (surgical site infection and/or seroma) was analyzed as a composite outcome via multivariate logistic regression adjusted for age, sex, BMI, ASA class, hernia type, smoking, symptom duration, contamination, and bowel resection, with a reduced four-covariate sensitivity model. Propensity-score matching, subgroup analyses by hernia type, and mesh-use/no-bowel-resection sensitivity analyses were also performed; all were prespecified but exploratory, without correction for multiple testing. RESULTS: Groups were comparable in baseline characteristics (all p > 0.05), with no postoperative deaths. Operative time was longer with laparoscopy (82.0 ± 16.7 vs. 76.0 ± 13.5 min, p = 0.025), while hospital stay was shorter (3.9 ± 1.0 vs. 5.2 ± 0.9 days, p < 0.001) and postoperative ileus less frequent (1.1% vs. 8.9%, p = 0.034). Wound complications were numerically lower after laparoscopy (13.3% vs. 22.2%) but not statistically significant (p = 0.172). No covariate independently predicted wound morbidity on multivariate analysis (technique OR 0.59, 95% CI 0.26-1.33, p = 0.203). Propensity-matched analysis (68 pairs) confirmed the operative-time and length-of-stay findings; the length-of-stay benefit was consistent across all hernia-type subgroups and sensitivity analyses. CONCLUSIONS: Laparoscopic repair of strangulated abdominal wall hernias was associated with shorter hospital stay and lower ileus rates, but longer operative time, than open repair, with no significant difference in wound morbidity or mortality. Given the non-randomized design and limited power for the wound-complication comparison (∼35%), these findings-particularly regarding wound morbidity-should be considered hypothesis-generating. Laparoscopic repair may be a reasonable option in carefully selected, hemodynamically stable patients, pending confirmation by adequately powered multicenter trials.