title: Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair.
abstract: OBJECTIVE
  To compare laparoscopic ventral hernia repair (LVHR) versus open ventral hernia repair (OVHR) for quality of life (QOL), complications, and recurrence in a large, prospective, multinational study.
  
  
  BACKGROUND
  As recurrence rates have decreased for LVHR and OVHR, QOL has become an extremely important differentiating outcomes measure.
  
  
  METHODS
  A prospective, international database was queried from September 2007 to July 2011 for LVHR and OVHR. Carolinas Comfort Scale (CCS) was utilized to quantify QOL (pain, movement limitation, and mesh sensation) preoperatively and at 1, 6, and 12 months postoperatively.
  
  
  RESULTS
  A total of 710 repairs included 402 OVHR and 308 LVHR. Demographics were mean age 57.1 ± 13.3 years, 49.6% male, 21.7% recurrent hernias, mean body mass index of 30.3 ± 6.6, and mean defect size of 89.4 ± 130.8. Preoperatively, 56.9% had pain, and 53.2% experienced movement limitation. At 1-month follow-up, 587 (82.7%) patients were provided CCS scores; more LVHR patients experienced pain (P < 0.001) and movement limitations (P < 0.001). At 6 and 12 months, there were no differences in QOL with 466 (65.6%) and 478 (67.3%) patients responding, respectively. After controlling for confounding variables, LVHR was independently associated with more frequent discomfort [odds ratio (OR) = 1.9, confidence interval (CI): 1.2-3.1], movement limitation (OR = 1.6, CI: 1.0-2.7), and overall symptoms (OR = 1.6, CI: 1.0-2.6) at 1 month. LVHR resulted in a shorter length of stay (LOS) (P < 0.001) and fewer infections (P = 0.004), but overall complication rates were equal. Recurrence rates were also equal (P = 0.66).
  
  
  CONCLUSIONS
  In the largest, prospective QOL study comparing LVHR and OVHR, LVHR is associated with a decrease in QOL in the short term. LOS and infection rates are decreased in LVHR, but overall complication and recurrence rates are equal.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Colavita
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Walters
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors