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TEP hernia repair patients have significant QOL improvements

Key clinical point: The majority of patients who have undergone laparoscopic totally extraperitoneal groin hernia repair report mild or no symptoms 2 years after the operation.

Major finding: More 90% of patients experience no or nonbothersome symptoms of sensation of mesh, pain or movement limitations at 2 years after laparoscopic totally extraperitoneal groin hernia repair.

Data source: Prospective study in 293 patients undergoing laparoscopic totally extraperitoneal groin hernia repair.

Disclosures: No conflicts of interest were declared.


 

FROM JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS

References

The majority of patients who have undergone laparoscopic totally extraperitoneal groin hernia repair report mild or no symptoms 2 years after the operation, results of a large prospective study indicate.

Researchers assessed 293 patients – 93% of whom were male – who underwent laparoscopic totally extraperitoneal (TEP) groin hernia repair, both before and 3 weeks, 6 months, 1 year, and 2 years after their operation, using the 36-Item Short Form Survey (v2), Surgical Outcomes Measurement System, and Carolinas Comfort Scale.

Courtesy Wikimedia Commons/Samuel Bendet/Creative Commons License

The study, published in the July issue of the Journal of the American College of Surgeons, found that 98% of individuals reported no or nonbothersome symptoms of sensation of mesh, 95% reported the same for pain, and 97% reported the same for movement limitations when assessed using the Carolinas Comfort Scale 2 years after surgery.

Pain scores, as measured by the Surgical Outcomes Measurement System, also improved significantly from baseline to 2 years after surgery (10 vs. 7.5; P = .025), and at all postoperative points, patients said they were highly satisfied with their quality of life.

“This study found that laparoscopic TEP groin hernia repair improves patient quality of life significantly, as evidenced by two generic and one procedure-specific quality of life instruments,” wrote Matthew E. Gitelis and his colleagues at the department of surgery at NorthShore University HealthSystem, Evanston, Ill. “Additionally, the procedure can be performed safely with minimal morbidity and low recurrence rates.”

According to the 36-Item Short Form Survey, patients showed significant improvements in physical functioning at 2 years after surgery, but not at 3 weeks, 6 months, or 1 year postoperatively. Pain scores initially increased at 3 weeks after surgery, compared with baseline, decreased to baseline levels at 6 months, then improved significantly at 1 and 2 years after surgery.

While surgery did not appear to affect energy/fatigue scores or emotional well-being, patients did report significant improvements in social functioning and role limitations (J Am Coll Surg. 2016 Jul;223:153-161). On average, patients used narcotic pain medication for 2.5 days after surgery, and returned to work and daily activities after 5.4 days.

The study also examined the technical outcomes of the operations, which were all performed by four surgeons specializing in minimally invasive and bariatric surgery at three sites across an academic-affiliated hospital system.

The authors said the decision was made to study the outcomes from more experienced surgeons because of the steep learning curves and specialized skill set required for laparoscopic techniques.

“Looking at the technical outcomes of our cohort as they relate to recurrence rates and complications, we continue to show the importance of reporting the experience of high-volume centers,” they wrote. “Our goal is to better understand the details and duration of quality of life outcomes so that we can better address patient expectations and provide important information used in the decision-making process for patients undergoing an elective procedure.”

There were 66 complications overall, most of which were from seroma (25 patients), hematoma (13 patients), and urinary retention (21 patients), with 7 cases of wound infection reported. Eight patients (2.2%) experienced a hernia recurrence.

“It is worth noting that, in the middle of our study, in an effort to decrease long-term postoperative pain, we switched to lighter-weight mesh (Physiomesh) from the polyester mesh (Parietex anatomical) used previously,” the authors reported. “Carolinas Comfort Scale scores at 1 year did confirm decreased pain scores; however, we also saw significantly higher rates of recurrence during that period.”

No conflicts of interest were declared.

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