Deborshi Sharma, Dr, Ranvir Singh, Dr, Romesh Lal, Dr. Lady Hardinge Medical College
INTRODUCTION – Laparoscopic ventral hernia repair (LVHR) has increased in popularity because of shorter recovery time due to less post-operative pain, wound complication and recurrences. This study aimed to assess and quantify pain and quality of life (QOL) after LVHR with or without endoscopic component separation (ECS) technique using visual analogue scale (VAS) and Carolina comfort scale (CCS).
METHODS AND PROCEDURES – Prospective study, which included 40 patients of ventral hernia, undergoing LVHR±ECS. Group I (n=15) – LVHR+ECS and Group II (n-25) – LVHR alone. Pain and quality of life was assessed by VAS and CCS at 1week, 1month, 3month after surgery. CCS score was derived by adding all 23 items with 0 as best possible and 115 as worst possible score. Complication like seroma, eventration and recurrence was assessed clinically and confirmed with ultrasound or computed tomography. Mann Whitney U test/t test and Chi-square test used and p values <0.05 were considered significant.
RESULTS – Demographics were similar in both groups like age in Group I (40.53+8.25) and group II (44.48+10.61). Females were 73.3% in group I while group II had 48% female. Pre-operative local site pain was present in 52% in group I while only 24% had in group II.
Post-operative pain was assessed by VAS at 1week, 1 month and 3 months along with QOL scoring done by CCS. Pain (Mean) at 1 week was 4.4+1.05 in Group I while it was 3.3+1.95 in group II (p-value 0.05). Group-I had significantly higher intensity pain compared to Group-II till 1 week however no significant difference was seen at 1month and beyond.
CCS at 1 week, 1 month and 3 months were 33.26+5.92 vs 28.96+5.02 (P-value 0.01), 19.47+7.27 vs 13.56+5.08 (p-Value 0.004) and 1.86+1.96 vs 0.56+1.19 (P-value 0.03) respectively for Group I & Group II. Group II had significantly better QOL, compared to Group I at follow-up of 1week, 1month & 3months.
Group I also had more post-operative complications than Group II in form of hematoma (6.70%vs0%), abscess (6.70%vs0%), mesh infection (6.70%vs0%), mesh removal (6.70%vs0%), post-operative ileus (6.70%vs0%). No recurrence was seen in either group.
Pain was significantly more at 1week in LVHR+ECS group while it was comparable at 1month. Significantly pain was absent in both groups at 3months.
Quality of life assessed by CCS was significantly better in patients undergoing LVHR only as compared to patients undergoing LVHR+ECS after 1 week, 1month and 3month post-operatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80862
Program Number: S053
Presentation Session: Ventral Hernias
Presentation Type: Podium