title: Does ventral hernia defect length, width, or area predict postoperative quality of life? Answers from a prospective, international study.
abstract: BACKGROUND
  The goal of this study was to determine if ventral hernia defect length, width, or area predict postoperative pain and quality of life following ventral hernia repair (VHR).
  
  
  METHODS
  The International Hernia Mesh Registry, a prospective database from 40 institutions worldwide, was queried for patients undergoing VHR from October 2007 to June 2012. Laparoscopic and open VHR were evaluated separately. Width and length were stratified into large, ≥10 cm and small, <10 cm, along with area as large, ≥100 cm(2) and small, <100 cm(2).
  
  
  RESULTS
  In total, 865 International Hernia Mesh Registry patients underwent VHR. Large defect width, length, and area had no association with hernia recurrence or reoperation in both open and laparoscopic VHR. There was a significant increase in operating room time and length of stay for large compared with small width, length, and area for open and laparoscopic VHR patients (P < 0.05). Large area was associated with increased seroma and ileus in open and laparoscopic VHR (P < 0.05). There was greater pain and activity limitation at 1 mo for large versus small width and area whether repaired laparoscopically or open (P < 0.05). When comparing large to small length, there was no difference in pain for all follow-up time points when repaired laparoscopically, but there is significantly increased odds of pain and activity limitation at 1, 6, and 12 mo when repaired open (P < 0.05).
  
  
  CONCLUSIONS
  Patients undergoing laparoscopic or open VHR with large defect widths and total area have a greater chance of pain and activity limitation at 1-mo follow-up, but not long term. Large defect lengths are associated with increased early and chronic discomfort in open VHR only.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28204, USA.
authors.forename: Blair Andrew
authors.initials: BA
authors.lastname: Wormer
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Walters
authors.forename: Joel F
authors.initials: JF
authors.lastname: Bradley
authors.forename: Kristopher B
authors.initials: KB
authors.lastname: Williams
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006555:Hernia, Ventral / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007391:International Cooperation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Carolinas Comfort scale; Complications; Defect size; Hernia; Incisional hernia; Laparoscopic; Pain; Quality of life; Recurrence; Ventral hernia