Medium-Term Recurrence and Quality of Life Assessment Using the Hernia-Specific Carolinas Comfort Scale Following Laparoscopic Inguinal Hernia Repair

Abstract

To determine the long-term outcomes and quality of life (QoL) following laparoscopic mesh repair of inguinal hernias using the hernia-specific Carolinas Comfort Scale(®) (CCS) questionnaire (Carolinas Laparoscopic and Advanced Surgery Program, Carolinas HealthCare System, Charlotte, NC). All patients who underwent elective primary or recurrent laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair from January 2005 to May 2010 were identified from a prospectively maintained clinical database. Baseline patient characteristics were recorded, including occupation, in addition to mean operating time, hernia recurrence rates, and postoperative CSS. Four hundred fifty-nine patients underwent surgery during the study period. The median follow-up interval from the date of operation to the date the questionnaire sent was 23 months (interquartile range, 32 months), and the total number of valid responses was 250. The median age of patients was 58 years (interquartile range, 21 years). The median operating time was 42 minutes (interquartile range, 21 minutes). Thirty-five patients (15%) and 15 patients (12%) had bilateral and recurrent hernia repairs, respectively. Three patients (1.1%) were confirmed to have hernia recurrence. Analysis of the CSS scores revealed that 41 patients (16%) reported pain, 44 (18%) reported mesh sensation, and 25 (10%) reported movement limitation. However, severe or disabling mesh-related symptoms were present in 5 patients (2%) for the pain category, in 8 patients (3%) for the mesh sensation category, and in 9 patients (3%) for the movement limitation symptom. The number of patients who were completely asymptomatic in all three symptom categories was 190 (24%). The only significant risk factor for developing mesh-related symptoms was young age at the time of surgery. Patient-reported medium-term symptoms following laparoscopic inguinal hernia repair appear common; however, the prevalence of severe or disabling symptoms is low.