Michael B Ujiki, MD, FACS, Chi Wang, PhD, Ryota Tanaka, MD, Mattew Gitelis, BS, Ermilo Barrera, MD, FACS, John Linn, MD, Steve Haggerty, MD, Zeeshan Butt, PhD, Joann Carbray, BS, Woody Denham, MD, FACS. NorthShore University HealthSystem, Northwestern Univeristy.
INTRODUCTION – Inguinal hernia repair is the most common surgical procedure performed in the world. Quality of life outcomes are probably the most important element of a successful repair. This study aimed to describe both short and long-term quality of life outcomes in a cohort of patients undergoing laparoscopic inguinal hernia repair.
METHODS AND PROCEDURES – We prospectively followed 288 patients who underwent totally extraperitoneal laparoscopic inguinal hernia repair as part of an Institutional Review Board-approved study. Short form-36 (SF-36) and Surgical Outcomes Measurement System (SOMS) were administered pre-operatively, at three weeks, six months, and one year post-operatively. A mixed-effect regression model was constructed with unspecified variance-covariance structure. Pair-wise comparisons were made between time points, and p-values were Bonferroni adjusted.
RESULTS – Mean age was 56.2 ±15.2 years and 92% were male. Mean body mass index was 26.4±3.7kg/m2. Eighty percent presented with painful hernias, the majority of which were described as mild. Hernias were unilateral right-sided in 48%, left-sided in 37%, and bilateral in 15%. Twenty-eight percent presented with a recurrent hernia. Average operative time was 46.0±23.3 minutes and there were no intra-operative complications. Urinary retention occurred in 16%. Length of stay averaged 10.8±10.1 hours. Visual analogue score at discharge was 1.9±1.7. Analgesics were used an average of 2.5±3.6 days and return to daily activities and work occurred on post-operative day 5.2±4.3 and 5.4±3.6 days respectively. Recurrence occurred in 2%. Role limitations due to physical health was significantly worse at week 3 (baseline 81.9 ±26.0 versus 68.8±29.0, p=0.02) but was significantly improved from baseline at one year (92.2±19.0, p<0.05). Energy and fatigue were significantly worse at week 3 (70.5±17.6 versus 65.5±20.6, p=0.01) but returned to baseline by 6 months. Pain significantly worsened at week 3 (84.6±19.1 versus 69.9±23.0, p 0.0006) but surpassed baseline at one year (91.2±14.0, p=NS). Social function significantly improved at one year (78.4±19.6 versus 83.8±11.2, p=0.0186).
CONCLUSIONS – Laparoscopic totally extraperitoneal hernia repair negatively affects role limitations due to physical health, energy/fatigue, and pain at three weeks but results in a significant improvement in social function and role limitations due to physical health at one year. On average, patients are able to return to activities of daily living and work within a week.
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