K. Bernardi1, J. L. Holihan1, D. V. Cherla1, J. R. Flores1, L. S. Kao1, T. C. Ko1, M. K. Liang1 1University Of Texas Health Science Center At Houston,General Surgery,Houston, TX, USA
Introduction:
Individuals with comorbid conditions (e.g. obesity or smoking) are not only at increased risk to develop a ventral hernia but are at markedly increased risk for complications (including recurrence) following repair. There is limited high-quality prospective data on the safety and efficacy of non-operative management of patients with ventral hernias. Our objective was to determine the long term clinical and patient reported outcomes of non-operative management of patients with comorbidities also suffering from ventral hernias.
Methods:
This is the 3-year follow-up to a prospective observational single institution study of patient with comorbidities and ventral hernias. Patients were contacted by phone to complete a standardized interview. Primary outcome was proportion of patients who underwent urgent or emergency surgery. Secondary outcomes were the change in quality of life (QoL) from their baseline interview and proportion of patients undergoing elective or emergent repair. QoL was measured utilizing the modified activities assessment scale (AAS), a validated, hernia-specific QoL survey. The minimal clinically important difference was considered a change of 7 points on a scale of 1-100 where 1=poor QOL and 100=perfect QOL.
Results:
Overall, 60 patients were followed to completion (Table below). At the end of 3 years, 3 (5%) patients had died due to non-hernia related causes, 16 (26.7%) patients had at least one emergency room visit related to their hernia, 4 (6.7%) patients underwent urgent/emergent ventral hernia repair, and 15 (25%) patients underwent elective ventral hernia repair. On average, non-operatively managed patients experienced no change in their QoL, while those who crossed over to operative management experienced a substantial improvement in their QoL.
Conclusion:
Non-operative management for patients with ventral hernias appears to be safe; however, there was a substantial crossover to operative intervention. For most patients who successfully completed non-operative management, their QoL did not change over 3 years. On the other hand, patients who underwent ventral hernia repair had a major improvement in their QoL.
