The Impact of Incisional Hernia Repair on the Quality of Life: A Narrative Review
Background: Incisional hernias represent a common complication following a midline incision, generating impairment, lower quality of life, and social costs. The aim of this narrative review is to determine in which manner risk factors – such as age, gender, postoperative complications, and even the overall health system – impact the satisfaction and expectations of the patients.
Methods: A literature search was performed through PubMed, Web of Science, and SpringerLink, addressing both international and national articles. Only full-text articles published in the last 12 years were chosen. Each individual positive or negative factor was then targeted.
Results: Statistically, the majority of patients were satisfied with the outcomes of the reparative surgery. Even so, complications can still occur, which are more likely to appear in the early postoperative stages. In most of these cases, the patients complained of strenuous movement, chronic pain, or recurrence, leaving the option of another surgical repair up to the patient’s wishes. On the one hand it seems that robotic-assisted surgery (RAS), absorbable sutures, suture fixation without tacks, and the male gender were associated with a better quality of life and less recurrence or other complications. On the other hand, lack of communication between patients and health personnel, chronic health diseases, and the female gender were linked to a tendency of developing more complications and therefore, a lower quality of life.
Conclusion: Statistically, in most of the cases, the patients were satisfied with the results. While it is safe to say that an incisional hernia repair increases the quality of life, there is still a small, but significant percentage of people that do not benefit from it as much as they expected. More awareness should be raised and the communication between patients and health personnel improved.
incisional hernia, postoperative hernia, incisional hernia repair, quality of life
 Rognoni, C., Cuccurullo, D., Borsoi, L., Bonavina, L., Asti, E., Crovella, F., Bassi, U. A., Carbone, G., Guerini, F., De Paolis, P., Pessione, S., Greco, V. M., Baccarini, E., Soliani, G., Sagnelli, C., Crovella, C., Trapani, V., De Nisco, C., Eugeni, E., . . . Piccoli, M. (2020). Clinical outcomes and quality of life associated with the use of a biosynthetic mesh for complex ventral hernia repair: Analysis of the “Italian Hernia Club” registry. Scientific Reports, 10(1), 10706. https://doi.org/10.1038/s41598- 020-67821-w
 Jensen, K. K., Emmertsen, K. J., Laurberg, S., & Krarup, P. M. (2020). Long-term impact of incisional hernia on quality of life after colonic cancer resection. Hernia, 24(2), 265–272. https://doi.org/10.1007/s10029-019-01978-w
 Snyder, C. W., Graham, L. A., Vick, C. C., Gray, S. H., Finan, K. R., & Hawn, M. T. (2011). Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: Effects of recurrence and repair technique. Hernia, 15(2), 123–129. https://doi.org/10.1007/s10029-010-0750-4
 Oma, E., Jensen, K. K., Jorgensen, L. N., & Bisgaard, T. (2020). Incisional hernia repair in women of childbearing age: A nationwide propensity score matched study. Scandinavian Journal of Surgery, 109(4), 295– 300. https://doi.org/10.1177/1457496919874482
 Rogmark, P., Smedberg, S., & Montgomery, A. (2018). Long-term follow-up of retromuscular incisional hernia repairs: Recurrence and quality of life. World Journal of Surgery, 42(4), 974–980. https://doi.org/10.1007/s00268-017-4268-0
 Sánchez, L. J., Piccoli, M., Ferrari, C. G., Cocozza, E., Cesari, M., Maida, P., Iuppa, A., Pavone, G., & Bencini, L. (2018). Laparoscopic ventral hernia repair: Results of a two thousand patients prospective multicentric database. International Journal of Surgery, 51, 31–38. https://doi.org/10.1016/j.ijsu.2018.01.022
 Belyansky, I., Daes, J., Radu, V. G., Balasubramanian, R., Reza Zahiri, H., Weltz, A. S., Sibia, U. S., Park, A., & Novitsky, Y. (2018). A novel approach using the enhanced view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surgical Endoscopy, 32(3), 1525–1532. https://doi.org/10.1007/s00464-017- 5840-2
 Poelman, M. M., Schellekens, J. F., Langenhorst, B. L. A. M., & Schreurs, W. H. (2010). Health-related quality of life in patients treated for incisional hernia with an onlay technique. Hernia, 14(3), 237–242. https://doi.org/10.1007/s10029-009-0619-6
 Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research, 63(11).
 Cherla, D. V., Moses, M. L., Viso, C. P., Holihan, J. L., Flores-Gonzalez, J. R., Kao, L. S., Ko, T. C., & Liang, M. K. (2018). Impact of abdominal wall hernias and repair on patient quality of life. World Journal of Surgery, 42(1), 19–25. https://doi.org/10.1007/s00268- 017-4173-6
 Baccari, P., Nifosi, J., Ghirardelli, L., & Staudacher, C. (2013). Short- and mid-term outcome after laparoscopic repair of large incisional hernia. Hernia, 17(5), 567– 572. https://doi.org/10.1007/s10029-012-1026-y
 Saijo, F., Tokumura, H., Narushima, Y., Matsumura, N., Sato, K., & Okazaki, Y. (2019). The quality of life after laparoscopic ventral and incisional hernia repair with closure and non-closure of fascial defect. Surgery Today, 49(11), 942– 947. https://doi.org/10.1007/s00595-019-01834-5
 Jani, K. (2018). Laparoscopic intra-peritoneal onlay mesh plus repair for ventral abdominal wall hernias - is there substance to the hype? Mini-invasive Surgery, 2(5), 14. https://doi.org/10.20517/2574-1225.2018.08
 Juvany, M., Hoyuela, C., Carvajal, F., Trias, M., Martrat, A., & Ardid, J. (2018). Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: Recurrence and quality of life. Hernia, 22(2), 319– 324. https://doi.org/10.1007/s10029-018-1730-3
 Sadava, E. E., Peña, M. E., Bras Harriott, C., Casas, M. A., Schlottmann, F., & Laxague, F. (2021). Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR). Surgical Endoscopy, 1, 1–6. https://doi.org/10.1007/S00464-021-08402-4/TABLES/3
 Mommers, E. H. H., Leenders, B. J. M., Leclercq, W. K. G., de Vries Reilingh, T. S., & Charbon, J. A. (2017). A modified Chevrel technique for ventral hernia repair: Long-term results of a single centre cohort. Hernia, 21(4), 591– 600. https://doi.org/10.1007/s10029-017-1602-2
 LeBlanc, K. A., Gonzalez, A., Dickens, E., Olsofka, J., Ortiz-Ortiz, C., Verdeja, J. C., Pierce, R., & the Prospective Hernia Study Group. (2021). Robotic-assisted, laparoscopic, and open incisional hernia repair: Early outcomes from the Prospective Hernia Study. Hernia, 25(4), 1071–1082. https://doi.org/10.1007/s10029-021-02381-0
 A Guzman-Pruneda, F., Huang, L. C., Collins, C., Renshaw, S., Narula, V., & K Poulose, B. (2021). Abdominal core quality of life after ventral hernia repair: A comparison of open versus robotic-assisted retromuscular techniques. Surgical Endoscopy, 35(1), 241–248. https://doi.org/10.1007/s00464-020-07386-x
 Wassenaar, E., Schoenmaeckers, E., Raymakers, J., van der Palen, J., & Rakic, S. (2010). Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: A randomized trial of three fixation techniques. Surgical Endoscopy, 24(6), 1296–1302. https://doi.org/10.1007/s00464-009-0763-1
 Bansal, V. K., Asuri, K., Panaiyadiyan, S., Kumar, S., Subramaniam, R., Ramachandran, R., Sagar, R., & Misra, M. C. (2016). Comparison of absorbable versus nonabsorbable tackers in terms of long-term outcomes, chronic pain, and quality of life after laparoscopic incisional hernia repair: A randomized study. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 26(6), 476–483. https://doi.org/10.1097/SLE.0000000000000347
 Claessen, J. J. M., Timmer, A. S., Atema, J. J., & Boermeester, M. A. (2021). Outcomes of mid-term and long-term degradable biosynthetic meshes in single-stage open complex abdominal wall reconstruction. Hernia, 25(6), 1647– 1657. https://doi.org/10.1007/s10029-021-02415-7
 Licari, L., Campanella, S., Carolla, C., Madonia, C., Canino, B., & Salamone, G. (2021). Abdominal wall incisional hernia repair improves respiratory function: Results after 3 years of follow-up. Hernia, 25(4), 999–1004. https://doi.org/10.1007/s10029-020- 02302-7
 Lee, T. J., Ulisney, K. L., Choudhuri, A. K., Swiger, J. L., & Gibeily, G. J. (2019). Understanding the patient perspective after ventral hernia repair. Hernia, 23(5), 995–1001. https://doi.org/10.1007/s10029-019-02015-6
 Langbach, O., Bukholm, I., Benth, J. Š., & Røkke, O. (2016). Long-term quality of life and functionality after ventral hernia mesh repair. Surgical Endoscopy, 30(11), 5023– 5033. https://doi.org/10.1007/s00464-016-4850-9
 van Veenendaal, N., Poelman, M. M., van den Heuvel, B., Dwars, B. J., Schreurs, W. H., Stoot, J. H. M. B., & Bonjer, H. J. (2021). Patient-reported outcomes after incisional hernia repair. Hernia, 25(6), 1677–1684. https://doi.org/10.1007/s10029-021-02477-7