The ACTIVE study: surgical outcomes for minimally invasive and open approach to incisional ventral hernias in a non-elective setting.

Background: Surgical repair of incisional ventral hernias (VH) is a standard procedure globally, with an increasing role in minimally invasive techniques. This study aims to evaluate postoperative outcomes in emergency repairs for VH, comparing surgical features of open and laparoscopic approaches.

Methods: A retrospective multicentric study (ACTIVE study) was created to evaluate the surgical outcome of VH repair in emergency settings. Data were collected from demographic, preoperative, intra-operative, and postoperative variables, focusing on 30-day morbidity and other short- and long-term outcomes.

Results: Data from 556 patients who underwent emergency VH repair were collected and analyzed, with 175 patients treated with a Minimally Invasive (MIS) approach (31.5%) and 381 (68.5%) receiving open repair. The defect size was larger in the open group (p < 0.001), and operative time was shorter in the MIS group (p = 0.002). Prosthetic repair was more frequently chosen in the MIS group (p < 0.001), with a shorter length of stay (p = 0.013). Postoperative complications and Intensive Care Unit admissions were higher in the open group. The MIS had shorter operative times, smaller defect sizes, and higher mesh usage, even with concurrent bowel resection.

Conclusions: This study confirmed the feasibility and safety of the laparoscopic approach to VH in emergency settings. Despite the lack of solid evidence for routine adoption in emergency settings, the MIS approach demonstrated a lower overall complication rate, shorter hospital stays, and reduced mortality. The laparoscopic approach is a safe and valid tool for tailored surgery, even in emergent settings in selected patients.