Langbach Odd, Bukholm Ida, Benth Jūratė Šaltytė, Røkke Ola
Department of Gastroenterologic Surgery, Akershus University Hospital, P.O. Box 1000, 1478, Lørenskog, Norway.
Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316, Oslo, Norway.
Surg Endosc. 2016 Nov;30(11):5023-5033. doi: 10.1007/s00464-016-4850-9. Epub 2016 Mar 11.
The absence of recurrence and pain are important for good quality of life (QoL) after ventral hernia mesh repair. We wanted to study long-term outcome after laparoscopic (LVHR) and open ventral hernia mesh repair (OVHR) using validated scales to measure QoL and functional outcome.
We conducted a single-center follow-up study of 194 consecutive patients after LVHR and OVHR between March 2000 and June 2010. Of these, 27 patients (13.9 %) died and 14 (7.2 %) failed to attend their follow-up appointment. Of 153 (78.9 %) patients who attended, 81 (52.9 %) patients had LVHR and 72 (47.1 %) patients had OVHR, including 11 conversions (surgery group). One hundred and twelve patients with non-recurrent ventral hernia were also enrolled consecutively as controls (non-surgery group). Quality of life was measured by the SF-36 short form questionnaire and functional outcome by the Activities Assessment Scale (AAS) with the revised Life Orientation Test to measure the influence of dispositional optimism on pain and functionality. Assessment of pain was done using a 100-mm visual analogue scale ruler anchored by word descriptors.
Median time from hernia mesh repair to follow-up was 48 and 52 months after LVHR and OVHR, respectively. There were no long-term differences between LVHR and OVHR measured by SF-36 and AAS. Physical dimensions in SF-36: physical function, restrictions in physical function and bodily pain, were significantly better in the surgery group compared to the non-surgery group, but only for incisional hernia. Recurrence was associated with a significant reduction in QoL in all dimensions of SF-36 in both hernia repair cohorts. Chronic pain and impairment were closely related. Optimistic patients had less impairment than pessimistic patients.
LVHR and OVHR reduce chronic pain and physical impairment and improve long-term QoL. Hernia recurrence and persistent pain reduce the beneficial effect of hernia surgery. Dispositional optimism can modulate QoL reporting and improve functionality.
腹疝补片修补术后无复发和疼痛对良好的生活质量（QoL）很重要。我们想使用经过验证的量表来测量生活质量和功能结局，研究腹腔镜腹疝修补术（LVHR）和开放腹疝补片修补术（OVHR）后的长期结局。
我们对2000年3月至2010年6月期间连续接受LVHR和OVHR治疗的194例患者进行了单中心随访研究。其中，27例患者（13.9%）死亡，14例患者（7.2%）未参加随访预约。在153例（78.9%）参加随访的患者中，81例（52.9%）接受了LVHR，72例（47.1%）接受了OVHR，其中包括11例中转手术患者（手术组）。还连续纳入了112例无复发性腹疝的患者作为对照组（非手术组）。使用SF-36简表问卷测量生活质量，使用活动评估量表（AAS）及修订后的生活取向测试测量功能结局，以评估性格乐观对疼痛和功能的影响。使用由文字描述词锚定的100毫米视觉模拟量表尺评估疼痛。
LVHR和OVHR后从疝补片修补到随访的中位时间分别为48个月和52个月。通过SF-36和AAS测量，LVHR和OVHR之间没有长期差异。SF-36中的身体维度：身体功能、身体功能受限和身体疼痛，手术组与非手术组相比显著更好，但仅针对切口疝。在两个疝修补队列中，复发与SF-36所有维度的生活质量显著降低相关。慢性疼痛和功能障碍密切相关。乐观的患者比悲观的患者功能障碍更少。
LVHR和OVHR可减轻慢性疼痛和身体功能障碍，并改善长期生活质量。疝复发和持续性疼痛会降低疝手术的有益效果。性格乐观可调节生活质量报告并改善功能。
