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©The Author(s) 2015.
World J Gastrointest Surg. Dec 27, 2015; 7(12): 384-393
Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.384
Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.384
Table 1 Patient and hernia characteristics (n = 155)
| Characteristics | Laparoscopic | Open | P value |
| Age (yr), mean ± SD | 56.5 ± 14.9 | 57.2 ± 11.6 | 0.76 |
| Gender: Male | 34 (41.5) | 34 (46.6) | 0.52 |
| BMI (kg/m2), mean ± SD | 30.7 ± 6.2 | 29.7 ± 5.3 | 0.29 |
| ASA class | 0.64 | ||
| I | 13 (15.9) | 13 (17.8) | |
| II | 62 (75.6) | 55 (75.3) | |
| III | 7 (8.5) | 5 (6.8) | |
| Charlson index score | 0.41 | ||
| Score 0 | 25 (30.5) | 16 (21.9) | |
| Score 1 | 14 (17.1) | 19 (26.0) | |
| Score 2 | 16 (19.5) | 19 (26.0) | |
| Score 3 | 16 (19.5) | 12 (16.4) | |
| Score 4, 5, 6 | 11 (13.4) | 7 (9.6) | |
| Type of co-morbidity | 0.64 | ||
| Hypertension/congestive heart disease | 23 (28.0) | 19 (26.0) | |
| 3COPD | 16 (19.5) | 12 (16.4) | |
| Diabetes | 5 (6.1) | 5 (6.1) | |
| Neurological disease | 2 (2.4) | 1 (1.4) | |
| Multimorbid | 0 | 3 (4.1) | |
| Miscellaneous | 8 (9.8) | 10 (13.7) | |
| Smoking | 28 (34.1) | 26 (35.6) | 0.85 |
| Hernia type | 0.96 | ||
| Incisional | 66 (80.5) | 59 (80.8) | |
| Non-incisonal | 16 (19.5) | 14 (19.2) | |
| Recurrent hernia | 15 (18.3) | 13 (17.8) | 0.94 |
| Hernia area (cm2) ± SD | 57.5 ± 56.9 | 44.9 ± 52.9 | 0.17 |
| 1Incsional hernia | 0.41 | ||
| Small/medium < 70 cm2 | 44 (67.7) | 41 (74.5) | |
| Large ≥ 70 cm² | 21 (32.3) | 14 (25.5) | |
| 2Non-incisonal hernia | 0.003 | ||
| Small/medium < 13 cm2 | 6 (40.0) | 13 (92.9) | 0.06 |
| Large ≥ 13 cm2 | 9 (60.0) | 1 (7.1) | |
| Hernia location | 0.40 | ||
| Midline | 74(90) | 67 (92) | |
| Others | 8 (10) | 6 (8) | |
| Mesh size (cm2), mean ± SD | 235.1 ± 113.4 | 184.5 ± 124.3 | 0.03 |
| Follow up (mo), median, range | 48 (9-88) | 52 (12-115) | 0.006 |
Table 2 Perioperative characteristics (n = 155)
| Laparoscopic | Open | P value | |
| Operative time, min, mean ± SD | 117 ± 54 | 92 ± 44 | 0.002 |
| Emergency hernia operation | 0 | 12 (16.4) | |
| Preoperative antibiotics | 30 (36.6) | 33 (45.8) | 0.24 |
| Postoperative antibiotics | 12 (14.6) | 17 (23.3) | 0.17 |
| Postoperative stay, d, median (IQR) | 2 (1-3) | 2 (1-4) | 0.67 |
| No. of trocars, median (range) | 3 (3-6) | - | - |
| No. of tackers | 28 (10-70) | - | - |
| Mesh types | |||
| Polypropylene | 0 | 27 (38.0) | |
| Marlex | 0 | 7 (9.9) | |
| Bard composix | 20 (25.0) | 5 (7.0) | |
| Parietex composite | 39 (48.8) | 9 (12.7) | |
| Proceed | 7 (8.8) | 1 (1.4) | |
| TiMESH | 2 (2.5) | 1 (1.4) | |
| Unknown | 0 | 6 (8.5) | |
| Unknown | 0 | 6 (8.5) |
Table 3 Perioperative, postoperative and late complications
| Laparoscopic | Open | P value | |
| Postoperative complications - grading | 0.39 | ||
| Minor (I- IIIa) | 18 (22.0) | 22 (30.1) | |
| Major (IIIb-IV) | 7 (8.5) | 8 (11.0) | |
| Postoperative complications - type | 0.17 | ||
| Wound infection | 6 (7.3) | 13 (17.8) | 0.05 |
| Seroma | 5 (6.1) | 14 (19.2) | 0.02 |
| Deep infection | 1 (1.2) | 1 (1.4) | |
| Pneumonia | 2 (2.4) | 1 (1.4) | |
| Unclassified infection | 3 (3.7) | 4 (5.5) | |
| Subcutaneous bleeding | 4 (4.9) | 2 (2.7) | |
| Substantial pain | 6 (7.3) | 3 (4.1) | |
| Others | 2 (2.4) | 2 (2.7) | |
| Intraoperative complications - type | 0.14 | ||
| Enterotomy | 0 | 4 (5.5) | |
| Colotomy | 1 (1.2) | 0 | |
| Late complications - type | 0.24 | ||
| Subileus/ileus | 3 (3.7) | 0 | |
| Deep infection | 1 (1.2) | 2 (2.7) | |
| Substantial pain | 4 (4.9) | 3 (4.1) | |
| Hematoma | 0 | 1 (1.4) | |
| Seroma | 4 (4.9) | 2 (2.7) | |
| Wound infection | 1 (1.2) | 4 (5.5) | |
| Others | - | 2 (2.7) |
Table 4 Overall recurrence after hernia surgery
Table 5 Predictors for overall recurrence after laparoscopic mesh repair univariate analysis
| Yes | No | P value | |
| Gender male/female | 7/7 | 27/41 | 0.48 |
| Age at hernia surgery; yr; mean ± SD | 52 ± 14 | 57 ± 15 | 0.24 |
| Period of follow-up, mo ± SD | 46 ± 15 | 46 ± 17 | 0.94 |
| Charlson index | 0.79 | ||
| 0 | 6 (24.0) | 19 (76.0) | |
| 1 | 2 (14.3) | 12 (85.7) | |
| 2 | 2 (12.5) | 14 (87.5) | |
| 3 | 3 (18.8) | 13 (81.3) | |
| 4, 5, 6 | 1 (9.1) | 10 (90.9) | |
| COPD | 3 (18.8) | 13 (81.3) | 0.84 |
| Smoking | 5 (17.9) | 23 (82.1) | 0.89 |
| BMI (kg/m2); mean ± SD | 34 ± 6 | 30 ± 6.0 | 0.05 |
| BMI (kg/m2); (%) 18.5-24.9 | 1 (8.3) | 11 (92.7) | 0.38 |
| BMI (kg/m2); (%) 25.0-29.9 | 3 (12.0) | 22 (88.0) | |
| BMI (kg/m2); (%) 30.0-39.9 | 10 (22.2) | 35 (77.8) | |
| Hernia type | 0.59 | ||
| Incisional | 12 (18.2) | 54 (81.8) | |
| Non-incisional | 2 (12.5) | 14 (87.5) | |
| Recurrent hernia | 2 (13.3) | 13 (86.7) | 0.67 |
| Hernia area, cm2, mean ± SD | 80 ± 58 | 53 ± 56 | 0.11 |
| Hernia area, both types < 58 cm2 | 5 (9.8) | 46 (90.2) | 0.04 |
| Hernia area, both types ≥ 58 cm2 | 8 (27.6) | 21 (72.4) | |
| Incisonal hernia area < 70 cm2, n1 | 6 (13.6) | 38 (86.4) | 0.15 |
| Incisonal hernia area ≥ 70 cm2, n | 6 (28.6) | 15 (71.4) | |
| Non-incisonal hernia area < 13 cm2, n | 0 | 6 | 0.40 |
| Non-incisonal hernia area ≥ 13 cm2, n | 1 (11.1) | 8 (88.9) | |
| No. of trocars, median, (range) | 4 (3-6) | 3 (3-5) | < 0.001 |
| Operative time, min, mean ± SD | 142 ± 63 | 112 ± 51 | 0.07 |
| Postoperative stay, d, mean ± SD | 4 ± 4 | 2 ± 1 | 0.001 |
| Preop antibiotics | 8 (26.7) | 22 (73.3) | 0.08 |
| Surgeons experience | 0.69 | ||
| Less experient | 7 (15.6) | 38 (84.4) | |
| Experient | 7 (18.9) | 30 (81.1) | |
| Mesh | 0.47 | ||
| Goretex | 3 (25.0) | 9 (75.0) | |
| Parietex | 7 (17.5) | 33 (82.5) | |
| Bard | 3 (15.0) | 17 (85.0) | |
| Other | 0 | 9 | |
| Postoperative complications | 5 (20.0) | 20 (80.0) | 0.64 |
| Postoperative antibiotics | 3 (25.0) | 9 (75.0) | 0.43 |
| Late complications | 2 (15.4) | 11 (84.6) | 0.86 |
| Hernia belt | 11 (22.0) | 39 (78.0) | 0.14 |
Table 6 Predictors for overall recurrence after laparoscopic mesh repair multivariate analysis adjusted model
Table 7 Predictors for overall recurrence after open mesh repair-univariate analysis
| Yes | No | P value | |
| Gender male/female | 9/8 | 25/31 | 0.55 |
| Age at hernia surgery, yr, mean ± SD | 57 ± 11 | 57 ± 12 | 1.0 |
| Period of follow-up, mo ± SD | 56 ± 26 | 57 ± 30 | 0.91 |
| Charlson index | 0.86 | ||
| 0 | 3 (18.8) | 13 (81.3) | |
| 1 | 6 (31.6) | 13 (68.4) | |
| 2 | 4 (21.1) | 15 (78.9) | |
| 3 | 3 (25.0) | 9 (75.0) | |
| 4, 5, 6 | 1 (14.3) | 6 (85.7) | |
| COPD | 3 (25.0) | 9 (75.0) | 0.88 |
| Smoking | 10 (38.5) | 16 (61.5) | 0.02 |
| BMI, kg/m2, mean ± SD | 31 ± 6.0 | 29 ± 5.1 | 0.25 |
| BMI (kg/m2) (%)18.5-24.9 | 2 (20.0) | 8 (80.0) | 0.80 |
| BMI (kg/m2) (%) 25.0-29.9 | 5 (19.2) | 21 (80.8) | |
| BMI (kg/m2) (%) 30.0-39.9 | 10 (27.8) | 26 (72.2) | |
| Emergency operation | 3 (25.0) | 9 (75.0) | 1.0 |
| Hernia type | 1.0 | ||
| Incisional | 14 (23.7) | 45 (76.3) | |
| Non-incisional | 3 (21.4) | 11 (78.6) | |
| Recurrent hernia | 2 (15.4) | 11 (84.6) | 0.72 |
| Hernia area, cm2, mean ± SD | 39 ± 56 | 47 ± 52 | 0.60 |
| 1Incisonal hernia area < 70 cm2 | 11 (26.8) | 30 (73.2) | 0.48 |
| Incisonal hernia area ≥ 70 cm2 | 2 (14.3) | 12 (85.7) | |
| Non-incisonal hernia area < 13 cm2 | 2 (15.4) | 11 (84.6) | 0.21 |
| Non-incisonal hernia area ≥ 13 cm2 | 1 | 0 | |
| Mesh area, cm2, mean ± SD | 186 ± 112 | 184 ± 131 | 0.97 |
| Operative time, min, mean ± SD | 97 ± 65 | 90 ± 36 | 0.56 |
| Preop antibiotics | 8 (24.2) | 25 (75.8) | 0.70 |
| Surgeons experience | 0.98 | ||
| Less experient | 6 (23.1) | 20 (76.9) | |
| Modest experient | 11 (23.4) | 36 (76.6) | |
| Mesh | 0.63 | ||
| Goretex | 4 (26.7) | 11 (73.3) | |
| Polypropylene | 5 (19.2) | 21 (80.8) | |
| Unknown | 0 | 6 | |
| Other | 5 (23.8) | 16 (76.2) | |
| Postoperative complications | 11 (36.7) | 19 (63.3) | 0.02 |
| Seroma | 5 (35.7) | 9 (64.3) | 0.22 |
| Wound infection | 4 (30.8) | 9 (69.2) | 0.48 |
| Postoperative antibiotics | 7 (52.9) | 10 (47.1) | 0.05 |
| Late complications | 5 (35.7) | 9 (64.3) | 0.22 |
| Postoperative stay, d, mean ± SD | 8 ± 19 | 2 ± 2 | 0.02 |
| Hernia belt | 5 (15.6) | 27 (84.4) | 0.54 |
Table 8 Predictors for overall recurrence after open mesh repair-multivariate analysis adjusted model
| OR (95%CI) | P value | |
| Smoking | 4.18 (1.22; 14.38) | 0.002 |
| Postoperative complications | 2.36 (0.49; 11.45) | 0.287 |
| Postoperative antibiotics | 1.36 (0.25; 7.43) | 0.722 |
| Postoperative stay | 1.18 (0.89; 1.57) | 0.254 |
Table 9 Predictors for abdominal wall pain measured on the visual analogue scale in relation to type of hernia surgery
| Laparoscopic n = 81 | Open n = 72 | OR1 (95%CI) | P value | |
| Maximum pain reported, mean ± SD | 16.7 (20.8) | 18.6 (20.8) | 1.40 (0.42-4.68) | 0.58 |
| Maximum pain on palpation, mean ± SD | 12.9 (20.2) | 12.1 (20.2) | 0.78 (0.26-2.32) | 0.66 |
| Pain on average, mean ± SD | 3.3 (10.3) | 2.4 (6.4) | 0.85 (0.49-1.47) | 0.56 |
| Pain during sedentary activities, mean ± SD | 6.5 (17.9) | 4.0 (15.4) | 0.61 (0.31-1.22) | 0.16 |
| Pain during work activities, mean ± SD | 9.8 (17.9) | 7.7 (15.4) | 0.68 (0.24-1.89) | 0.46 |
Table 10 Predictors for pain after laparoscopic mesh repair and open mesh repair
| Maximum pain | Average pain | Pain, sedentary | Pain, work | |
| OR (95%CI)2 | OR (95%CI)3 | OR (95%CI) | OR (95%CI) | |
| 1 | LVHR | LVHR | LVHR | |
| Gender | 7.372 (1.4-39.9) | NA | NA | NA |
| Age | 19.773 (3.4-115.5) | NA | 3.713 (1.1-12.6) | 7.043 (1.5-33.0) |
| BMI | 14.564 (2.4-90.0) | 5.034 (1.4-18.3) | 7.244 (1.5-35.1) | 9.734 (1.3-73.0) |
| COPD | NA | NA | NA | NA |
| Clinical recurrence excluded | ||||
| LVHR | 32.04 (2.82-363.22) | NA | 5.78 (1.11-30.05) | 14.22 (1.75-116.05) |
| OVHR | 18.04 (1.80-181.1) | NA | NA | NA |
Table 11 Predictors for chronic pain after laparoscopic mesh repair-multivariate analysis (n = 81)
| OR (95%CI) | P value | |
| Clinical recurrence | 11.67 (2.00-68.24) | 0.006 |
| Late complications | 5.47 (1.1-27.09) | 0.037 |
| Gender (referes female) | 0.42 (0.10-1.98) | 0.274 |
| Age > 60 yr | 0.23 (0.03-1.51) | 0.125 |
| COPD | 2.39 (0.52-11.10) | 0.265 |
| Smoking | 1.38 (0.37-5.11) | 0.629 |
Table 12 Predictors for chronic pain after open mesh repair-multivariate analysis (n = 71)
| OR (95%CI) | P value | |
| Clinical recurrence | 1.20 (0.24-6.06) | 0.828 |
| Smoking (crude model) | 3.86 (1.24-12.00) | 0.020 |
| Smoking (adjusted model) | 3.81 (0.95-15.33) | 0.060 |
| Hernia size > 70 cm2 | 0.84 (0.13-5.53) | 0.852 |
| Gender (ref female) | 0.30 (0.07-1.35) | 0.116 |
| Postoperative complications | 3.59 (0.76-16.88) | 0.106 |
| Late complications | 1.16 (0.20-6.87) | 0.869 |
| Postoperative stay | 1.08 (0.75-1.57) | 0.668 |
Table 13 Predictors for satisfaction after laparoscopic mesh repair-multivariate analysis (n = 79)
| OR (95%CI) | P value | |
| Chronic pain1 | 0.14 (0.03-0.70) | 0.017 |
| Age > 60 yr | 7.16 (1.37-37.42) | 0.020 |
| Gender (ref female) | 2.69 (0.72-10.05) | 0.142 |
| Time to follow up | 0.55 (0.33-0.90) | 0.019 |
| Clinical recurrence (crude model) | 0.13 (0.03-0.65) | 0.013 |
| Clinical recurrence (adjusted model) | 0.13 (0.02-1.11) | 0.062 |
| Late complications | 0.39 (0.07-2.23) | 0.289 |
Table 14 Predictors for satisfaction after open mesh repair-multivariate analysis (n = 71)
| OR (95%CI) | P value | |
| Chronic pain1 | 0.18 (0.04; 0.81) | 0.025 |
| Age > 60 yr | 0.05 (0.01; 0.47) | 0.008 |
| Gender (ref female) | 0.26 (0.05; 1.37) | 0.111 |
| Time to follow up | 0.71 (0.49; 1.03) | 0.073 |
- Citation: Langbach O, Bukholm I, Benth J&, Røkke O. Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair. World J Gastrointest Surg 2015; 7(12): 384-393
- URL: https://www.wjgnet.com/1948-9366/full/v7/i12/384.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v7.i12.384