J. L. Holihan1, Z. M. Alawadi1, J. R. Flores-Gonzelez1, T. C. Ko1, L. S. Kao1, M. K. Liang1 1University Of Texas Health Science Center At Houston,Surgery,Houston, TX, USA
Introduction: Little is known about clinical or patient-reported outcomes (PRO) with non-operative management of patients with a ventral hernia. The aim of this prospective study is to determine the outcomes of patients undergoing initial non-operative treatment of their ventral hernia.
Methods: A prospective, longitudinal study of patients undergoing non-operative management of their ventral hernia at a safety-net hospital was initiated in 2014. Non-operative management was elected either by the surgeon based upon poor predicted risk-benefit ratio or by the patient. Primary outcome was rate of surgical repair of the ventral hernias. Secondary outcomes included rate of emergency repair, elective repair, and emergency room visits. Validated surveys for patient satisfaction, cosmetic satisfaction, abdominal pain, and patient function (modified Activities Assessment Scale, AAS) were utilized. Baseline and 6-month follow up surveys were compared using a Wilcoxon signed rank test with p<0.05 considered significant.
Results: Of 114 patients who underwent non-operative management of their ventral hernia, 85 (74.6%) were followed for a median (interquartile range) of 7.8 (5.6-9.0) months. Reasons for non-operative management were obesity (81, 71.1%), smoking (22, 19.2%), other co-morbidities (23, 20.2%), patient choice (10, 8.8%), and surgical complexity (3, 2.6%). Six (7.1%) patients underwent ventral hernia repair following enrollment: 4 (4.7%) were repaired electively and 2 (2.4%) were repaired emergently. Among those undergoing elective repair, 3 patients met their goals required for elective surgery (weight loss and/or smoking cessation) and one underwent surgery at another institution. Ten (11.8%) patients had at least 1 emergency room visit associated with their hernia. Based on the modified AAS survey, patients who were managed non-operatively had increased feelings of sadness because of their hernia during the time they were followed (p=0.045) and worsening overall functional status (p=0.049). Patients who were converted to operative management had improved satisfaction with their abdominal wall (p=0.027), satisfaction with the appearance of their abdominal wall (p=0.027), and improvement in how much their abdominal wall affected them at work (p=0.034). There were no differences in abdominal wall pain (table).
Conclusion: Patients who undergo non-operative management of their ventral hernias experience significant declines in patient-reported outcomes. While the short-term risk of emergency surgery among patients with ventral hernias managed non-operatively is low, the long-term risk is unknown. Patients with ventral hernias should be optimized so that they can undergo elective repair.
