title: Open Versus Laparoscopic Management of Incisional Abdominal Hernia: Cohort Study Comparing Quality of Life Outcomes.
abstract: OBJECTIVE
  Incisional hernia is a common complication of laparotomy. The long-term effectiveness of the laparoscopic repair compared to the open approach remains to be proven. We investigated the 1-year impact of open and laparoscopic repair of incisional hernia on quality of life outcomes.
  
  
  METHODS
  Single-center cohort study. The clinical data of patients who underwent open or laparoscopic surgery for primary midline incisional hernia were retrieved from hospital records and from a research database. Criteria of exclusion were emergency procedures, associated bowel resection, and recurrent incisional hernia. Complications and recurrence rates were analyzed. The visual analog scale (VAS) and the Short-Form 36 (SF-36) were used to assess pain and quality of life 1 year after surgery in patients free of recurrence.
  
  
  RESULTS
  One hundred twenty-four patients were eligible for inclusion in the study. The mean follow-up was 3 ± 2 years (interquartile range [IQR] 2.0). Overall, 9% of patients in the open group and 7% in the laparoscopic group presented with hernia recurrence (P = .685). Sixty-six of the 124 patients, who were operated between 2009 and 2014 by the same surgical team with expertise in advanced laparoscopic surgery, were considered for the study. Nine (14%) of these patients were lost to follow-up and three (5%) had a recurrent hernia, reducing the final sample size to 54 patients of whom 26 operated through an open approach and 28 through laparoscopy. The two groups were comparable according to demographic variables, comorbidity, and postoperative morbidity. The laparoscopic approach required less operative time (<.001) and length of hospital stay (P = .002). The VAS and the SF-36 scores were similar in the 54 patients, 26 in the open group and 28 in the laparoscopic group, who completed the 1-year assessment.
  
  
  CONCLUSIONS
  Health-related quality of life at 1 year was similar in patients undergoing open or laparoscopic repair of incisional abdominal hernia.
authors.affiliation: Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan , IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy .
authors.forename: Emanuele
authors.initials: E
authors.lastname: Asti
authors.affiliation: Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan , IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Sironi
authors.affiliation: Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan , IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Lovece
authors.affiliation: Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan , IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy .
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bonitta
authors.affiliation: Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan , IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy .
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011184:Postoperative Period; D011788:Quality of Life; D012008:Recurrence