Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2015; 7(12): 384-393
Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.384
Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair
Odd Langbach, Ida Bukholm, Jūratė Šaltytė Benth, Ola Røkke
Odd Langbach, Ola Røkke, Department of Gastroenterologic Surgery, Akershus University Hospital, 1478 Lørenskog, Akershus, Norway
Odd Langbach, Ida Bukholm, Ola Røkke, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
Ida Bukholm, Department of Endocrin Surgery, Akershus University Hospital, 1478 Lørenskog, Akershus, Norway
Jūratė Šaltytė Benth, Institute of Clinical Medicine, Campus Ahus, University of Oslo, HØKH Research Centre, Akershus University Hospital, 1478 Lørenskog, Akershus, Norway
Author contributions: Langbach O extracted the data from the patients’ medical records, examined all patients and wrote the manuscript; Røkke O was responsible for the study design, analysis and interpretation of data and revision of the final manuscript; Bukholm I participated in the design and revision of the final manuscript; Benth JS contributed to the statistical analysis and revision of the manuscript.
Supported by Akershus University Hospital, No. 2619046.
Institutional review board statement: The study was reviewed and approved by the Data Protection Official for Research at Akershus University Hospital.
Informed consent statement: All study participants were legally independent individuals and provided informed written consent prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: Dataset available from the first author at odd.langbach@ahus.no. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Odd Langbach, MD, DDS, Chief, Department of Gastroenterologic Surgery, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Akershus, Norway. odd.langbach@ahus.no
Telephone: +47-67960000 Fax: +47-67963139
Received: June 26, 2015
Peer-review started: June 28, 2015
First decision: September 17, 2015
Revised: September 30, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: December 27, 2015
Processing time: 181 Days and 7 Hours
Abstract

AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.

METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients (13.9%) died and 12 (6.2%) failed to attend their follow-up appointment. One hundred and fifty-three (78.9%) patients attended for follow-up and two patients (1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82 (52.9%) patients had received laparoscopic ventral hernia mesh repair (LVHR) while 73 (47.1%) patients had undergone open ventral hernia mesh repair (OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale (VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.

RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain (VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.

CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.

Keywords: Female; Ventral/surgery; Herniorrhaphy/methods; Laparoscopy; Male; Pain; Patient satisfaction; Postoperative complications/epidemiology; Recurrence; Hernia

Core tip: This is an observational and retrospective study of laparoscopic and open ventral mesh repair involving both incisional and non-incisional hernias. The principal outcome measures were recurrence, abdominal pain and satisfaction. Of the original cohort of 194 patients, 153 patients (78.9%) were examined individually with a mean follow-up period of 51 mo. Our results demonstrate an overall recurrence rate of 16.1% and we discuss the potential reasons. Excluding clinical recurrence, 13.7% suffered from chronic pain and 55.3% were satisfied with the outcome. Laparoscopic and open ventral mesh repair are comparable with respect to outcome measures.