Department of Surgery, Amsterdam University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Department of Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Hernia. 2021 Dec;25(6):1677-1684. doi: 10.1007/s10029-021-02477-7. Epub 2021 Aug 2.
Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up.
Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed.
Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight.
This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients' expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.
患者报告的结局（PROs）对于评估手术治疗的疗效至关重要。关于修复切口疝的最佳手术技术仍存在争议。PROs 的评估可以指导选择切口疝患者的最佳治疗方法。本队列研究的目的是在长期随访时呈现切口疝修复后的 PROs。
在门诊就诊时，对有切口疝修复史的患者收集 PROs。患者被问及手术修复的术前指征以及术后症状，如疼痛、不适感和腹壁膨出。此外，还询问了患者的满意度，并完成了卡罗莱纳舒适度量表。
共纳入 210 例切口疝修复患者，中位随访时间为 3.2 年。切口疝修复的主要指征是存在膨出（60%）。其他主要修复原因是疼痛（19%）或不适（5%）。132 例患者（63%）报告手术后腹壁整体状况有所改善。133 例患者（63%）报告有术后症状，如不适感、疼痛和腹壁膨出。20%的患者报告说手术后腹壁的整体状况与术前相同，17%的患者报告说比术前更差。10%的患者会后悔选择手术。
本研究表明，大多数切口疝修复患者在手术后 3 年仍报告疼痛或其他症状，如不适感、疼痛和腹壁膨出。在术前咨询讨论中需要纳入患者的期望和 PROs，以改善切口疝手术的决策。
