QUALITY OF LIFE AND PATIENT-REPORTED OUTCOMES FOLLOWING ONLAY VERSUS SUBLAY MESH REPAIR IN VENTRAL HERNIA: A RANDOMIZED CONTROLLED TRIAL
Main Article Content
Keywords
Ventral hernia; Mesh repair; Patient-reported outcomes; Quality of life; VAS; SF- 36.
Abstract
Background: While surgical outcomes such as recurrence and wound complications remain primary endpoints in hernia repair studies, patient-reported outcomes (PROMs) have emerged as equally important measures of success. These include postoperative pain, physical function, and health-related quality of life (HRQoL).
Objective: To compare PROMs, including pain and HRQoL, in patients undergoing onlay versus sublay mesh repair for ventral hernia.
Methods: A randomized controlled trial was conducted with 60 patients, equally allocated to onlay (n=30) and sublay (n=30) mesh repair groups. Pain was assessed using Visual Analogue Scale (VAS) at 24 hours, 48 hours, 1 week, and 1 month. Quality of life was assessed using the Short Form-36 (SF-36) questionnaire preoperatively and at 3 months post-surgery. Statistical analysis was performed using Student’s t-test for continuous variables and Chi-square test for categorical variables, with p<0.05 considered significant.
Results: Sublay repair was associated with significantly lower VAS scores at 24 hours (5.2 ± 1.3 vs 6.4 ± 1.5, p=0.01) and 48 hours (3.8 ± 1.1 vs 4.9 ± 1.4, p=0.02). At 1 week and 1 month, pain remained lower in sublay patients but differences were not statistically significant. At 3 months, SF-36 showed significantly better scores in physical functioning (78.5 ± 8.3 vs 71.2 ± 7.9, p=0.01) and general health (74.6 ± 7.4 vs 68.1 ± 8.1, p=0.02) in the sublay group. Other domains including mental health and role emotional did not differ significantly.
Conclusion: Sublay mesh repair results in reduced early postoperative pain and improved physical aspects of quality of life compared with onlay repair, underlining its advantage not only in surgical outcomes but also in patient-centered recovery.
References
2. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am. 2003;83(5):1045-51.
3. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578-83.
4. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg. 2008;206(4):638-44.
5. Koltz PF, Frelich MJ, Tessier DJ. Quality of life after ventral hernia repair: a prospective observational study. Am J Surg. 2012;204(1):28-33.
6. Rives J, Lardennois B, Pire JC, Hibon J. Les grandes éventrations. Chirurgie. 1973;99(7):547-63.
7. Venclauskas L, Silanskaite J, Kanisauskas M, Kiudelis M. Long-term results of incisional hernia treatment: a comparative randomized study. Hernia. 2010;14(6):575- 82.
8. Saber A, Gad MA, Ellabban GM. Onlay versus sublay mesh repair for ventral hernia. J Surg. 2014;12(1):23-9.
9. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Evaluation of quality of life and function after abdominal wall reconstruction. Surgery. 2012;152(3):369-76.
10. Bosi HR, Cavazzola LT, Cavazzola L. Onlay versus sublay technique for treatment of incisional hernia: a systematic review. Arq Bras Cir Dig. 2018;31(3):e1384.