Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study

Background Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Metho...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 36; no. 2; pp. 951 - 958
Main Authors:	Kohler, Andreas, Lavanchy, Joël L., Gasser, Rahel, Wyss, Roland, Nowak, Lars, Scheiwiller, Andreas, Hämmerli, Peter, Candinas, Daniel, Beldi, Guido
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-02-2022 Springer Nature B.V
Subjects:	Abdominal Surgery Endoscopy Fascia Gastroenterology Gynecology Hepatology Hernia, Ventral - complications Hernia, Ventral - surgery Hernias Herniorrhaphy - adverse effects Herniorrhaphy - methods Hospitals Humans Incisional Hernia - complications Incisional Hernia - surgery Laparoscopy Laparoscopy - adverse effects Laparoscopy - methods Length of stay Medicine Medicine & Public Health Observational studies Pain Pain, Postoperative - epidemiology Pain, Postoperative - etiology Pain, Postoperative - surgery Patients Polyesters Prevalence Proctology Propensity Score Prospective Studies Recurrence Surgery Surgical Mesh - adverse effects Surgical techniques Sutures Thoracic surgery Propensity score matching Long-term follow up Pain Mesh fixation Multicenter study Incisional hernia
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Summary:	Background Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Methods A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. Results Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). Conclusions At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-021-08355-8