Health-related quality of life in patients treated for incisional hernia with an onlay technique

An incisional hernia is a frequent complication of abdominal surgery. The repair of incisional hernias comes with a high risk of reherniation and serious complications. With the introduction of mesh repair, recurrence rates have decreased and subsequent clinical outcomes have improved. Whereas further research needs to be done to improve complication rates and recurrence, the focus has now been placed on quality-of-life outcomes in patients undergoing these repairs. The aim of this study was to investigate the long-term health-related quality of life (HRQL) of patients who were treated for incisional hernias using an onlay technique.

Over a period of 10 years (1997-2007), 101 patients with an incisional hernia were treated with an onlay marlex mesh, fixed on the fascia with skin staples. Of the 101 patients, there were 45 males and 56 females, and their mean age was 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 35 months). The Short Form 36 (SF-36) and the Karnofsky Performance Status Scale (KPS) and a semi-structured interview were used to measure HRQL.

Seventy-one of the 101 patients were evaluated at our out-patient clinic. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The median admission time was 4.5 days (quartiles 3-6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of the 101 patients (27%) and a wound infection in 22 patients (21%), of which five patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation be scored; this occurred in 11 of 71 patients (16%). The evaluation of HRQL showed equal SF-36 scores for patients treated for an incisional hernia compared to their matched controls. Patients with a history of an open-abdominal treatment did not score significantly lower compared to patients without such a treatment. The median KPS score was 75, indicating that activities could be performed with effort and patients had some signs of disease.

HRQL is the same in patients treated for an incisional hernia compared to the matched controls. Therefore, the onlay technique seems to be an acceptable method to repair large incisional hernias.