H M Hedberg1, T Hall1, M E Gitelis1, B Lapin1, Z Butt2, J G Linn1, S Haggerty1, W Denham1, J Carbray1, M B Ujiki1. 1NorthShore University Healthsystems, 2Northwestern University
INTRODUCTION: Repair of asymptomatic inguinal hernias is a controversial topic. Clinical judgment must weigh the small risk of incarceration or strangulation with the risk of early and late operative complications such as chronic pain. Laparoscopy offers the benefit of reduced postoperative pain, and may strengthen the case for repair. The goal of this study is to compare general and disease specific quality of life after laparoscopic repair of asymptomatic and symptomatic inguinal hernias.
METHODS AND PROCEDURES: A review of prospectively collected data was conducted of 387 patients who underwent laparoscopic inguinal hernia repair (LIHR) between 2009 – 2015. All repairs were performed by four surgeons at a single institution using totally extraperitoneal (TEP) technique. Asymptomatic individuals were identified by self-reported pain scores of zero at preoperative clinic visits. Quality of life outcomes were measured using Short Form-36 (SF-36), Surgical Outcomes Measurement System (SOMS), and Carolinas Comfort Scale (CCS) administered preoperatively and at 3 weeks, 6 months, and 1 year post-operatively. Comparisons between preoperatively asymptomatic and symptomatic hernias were made using a chi-square test or t-test. Changes over time were assessed using mixed effects models.
RESULTS: A cohort of 79 patients were identified as asymptomatic and were compared to 308 symptomatic individuals. Both groups underwent elective TEP LIHR and completed validated quality of life surveys. The asymptomatic cohort had larger hernia defects (2.5cm vs 2cm, p=<0.01), was older (63.0 vs 58.9 years, p=0.03), included more femoral hernias (6.3% vs 1.0%, p=0.01), took pain medication for fewer days (1.2±1.5d vs 2.2±3.0d, p=0.02), and returned to baseline activities of daily living earlier (3d vs 5d, p=<0.01). The asymptomatic cohort reported decreased postoperative pain as measured by both SOMS and CCS over time (p=<0.01 and p=0.02, respectively). There was no significant difference in SF-36 over time. There was one recurrence in the asymptomatic group and two in the symptomatic cohort.
CONCLUSIONS: In this review of 387 patients, individuals with asymptomatic inguinal hernias repaired by TEP tended to be older and have larger hernia defects than symptomatic individuals. Over the first postoperative year the asymptomatic cohort reported less postoperative pain, and both returned to baseline activities of daily living and discontinued pain medication sooner. These short-term results are encouraging and can help inform patient-centered discussions about asymptomatic hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79548
Program Number: S109
Presentation Session: Hernias: Inguinal and Robotics
Presentation Type: Podium