Comparing 30-day outcomes between different mesh fixation techniques in minimally invasive inguinal hernia repair
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ORIGINAL ARTICLE
Comparing 30‑day outcomes between different mesh fixation techniques in minimally invasive inguinal hernia repair S. Tish1,3 · D. Krpata1 · R. AlMarzooqi1 · L.‑C. Huang2 · S. Phillips2 · A. Fafaj1 · L. Tastaldi1 · H. Alkhatib1 · S. Zolin1 · C. Petro1 · M. Rosen1 · A. Prabhu1 Received: 7 September 2019 / Accepted: 4 January 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose The association of postoperative patient-reported outcomes and type of mesh fixation during minimally invasive inguinal hernia repair has not been well characterized. We aimed to compare the 30-day quality of life outcomes between various mesh fixation techniques utilizing the AHSQC prospective registry. Methods All minimally invasive inguinal hernias with completed 30-day follow-up were abstracted from the AHSQC, excluding patients with primary indication for surgery being chronic groin pain. Mesh fixation was categorized as (1) atraumatic fixation (AF) (2) traumatic non-suture (TNS), (3) traumatic suture (TS). Our outcomes of interest were pain at site at 30-day and EuraHS quality of life assessment. Results After applying inclusion and exclusion criteria, 864 patients had surgical site pain and quality of life outcomes reported; 253 (AF), 451 (TNS), and 160 (TS). After adjusting for identified confounders, there was no statistically significant difference between any fixation method when evaluating pain as a binary variable (Yes/No). However, when looking at the EuraHS evaluation for pain and quality of life outcomes, AF was associated with better scores than both TNS and TS fixation in the cosmetic, restrictions, and overall EuraHS domains. AF was only better than TS fixation in the pain domain. Conclusion Our study suggests that AF had a significantly improved hernia-specific quality of life in all domains at 30-days postoperatively. We also identified that pain as a binary variable is inadequate for its states purpose. Thus, the overall wellbeing and morbidity should be taken into account when evaluating hernia patients postoperatively. Keywords EuraHS · Patient-reported outcomes · Quality of life · Inguinal hernia
Introduction Minimally invasive inguinal hernia repair has a well-established reputation for decreased postoperative pain and disability, earlier return to work and activities of daily living, and equivalent recurrence rates compared to open approaches [1]. The two main approaches to minimally invasive inguinal * S. Tish [email protected] 1
Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
2
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
3
Department of General Surgery, Washington University in Saint Louis, 1 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, USA
hernia repair are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). Similar outcomes may be expected between the two approaches assuming similar hernia disease [2]. Still
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