Patient-Centered Outcomes Following Laparoscopic Ventral Hernia Repair: A Systematic Review of the Current Literature.

Michael Sosin, MD, Ketan M Patel, MD, Lucy Guevara, Maurice Y Nahabedian, MD, Parag Bhanot, MD. Georgetown University Hospital, Division of General Surgery.

Background
Health related quality of life (HRQoL) measures are becoming increasingly important in defining successful outcomes in ventral hernia repair (VHR). The purpose of this study was to systematically review patients that underwent laparoscopic ventral hernia repair (LVHR) and assess QoL, pain, functionality, and patient satisfaction.
Methods
MEDLINE Pubmed and Cochrane databases were searched, and 880 articles were identified. After limits were applied, 14 articles were accepted for review. Analysis included HRQoL measures including quality of life, pain, function, satisfaction with surgery, and mental and emotional well-being.
Results
Of the 14 included studies, 50% were randomized prospective trials, 42.9% were nonrandomized prospective cohort studies, and 7.1% were nonrandomized retrospective cohort studies. Mean study size was 92.6 subjects (24-306), and mean defect size was 71.7cm2. LVHR improved overall HRQoL in 75% (6/8) studies. Thirteen studies assessing pain demonstrated that LVHR improved pain scores relative to preoperative levels or over time as significant improvements ranged from 2 weeks to 2 years postoperatively. LVHR was not associated with long term pain. Functionality improved in 12 studies. Return to work ranged from 6-18 days postoperatively in 50% of studies, and physical function scores improved in the remaining 50% of the studies. Patient satisfaction improved after LVHR in all four studies assessing patient satisfaction. Method of fixation did not influence HRQoL. Laparoscopic repair was associated with improving mental and emotional well-being as described in 85.7% (6/7) of studies.
Conclusions
Patients with a ventral hernia are likely to report a lower HRQoL than the general population. Laparoscopic VHR improves patient-centered outcomes measures including overall HRQoL, physical function, decreased long term pain, patient-reported satisfaction after surgery, and emotional and mental well-being.