QUALITY OF LIFE ASSESMENT BEFORE AND AFTER LAPARO/ENDOSCOPIC AND OPEN MESH HERNIOPLASTY-A PROSPECTIVE STUDY

Abstract

Background: Chronic pain is the most common and serious complication following inguinal hernia repair. the post-operative pain may result due to fixation of mesh with staples . The recurrence rates for laparoscopic repairs have been: TAPP, 1.0–4.3% and TEP, 0–4%.
Methods: This is a prospective observational  study of 60 patients suffering from groin hernia.The study was conducted in the post graduate department of surgery, GMC Srinagar for a period of one year from November 2022 to October 2023. Patients were subjected to general anesthesia or regional anesthesia. The study  included symptoms of patients suffering from groin hernia before and after surgery.Pre and post-operative assessment of patients were done regarding pain, sexual activity, cosmetic appearance (groin bulge) and complications following surgery.Pre-operative assessment of pain was done by VAS(visual analogue scale).Post-operative assessment of pain and sensation of mesh in patients will be based on CCSS (Carolina comfort scale score).
Results: The age of the patients in our study ranged from 20 to 90 years with maximum patients in the range of 41-50 years with a mean age was 51.75 years, Out of our 60 patients 45 patients were having pre-operative pain ranging between 1-7 as per VAS score, with a mean VAS score of 2.75, Out of our 60 patients 18 patients underwent Lichtenstein procedure, 33 underwent TAPP and 9 underwent TEP, During TAPP procedure 2 patients had inferior epigastric vessel injury and during TEP 4 patients had peritoneal tear, At 24 hours follow up pain assessment using VAS score was a mean VAS score of 4.3095 for Laparoscopic methods (TAPP & TEP) and a mean VAS score of 5.0556 for Open method (Lichtenstein) with a significant statistical p value of    p= 0.009, At 1 week follow up pain assessment using VAS score was a mean VAS score of 2.333 for Laparoscopic methods (TAPP & TEP) and a mean VAS score of 3.6667 for Open method (Lichtenstein) with a significant statistical p value of    < .001, Among patients who underwent open procedure 9 had wound seroma, 7 had surgical site infection and 7 had developed hematomas within 30th postoperative day. Among patients who underwent TAPP 3 had developed port site seroma within 30th postoperative day, 2 had developed port site infection and 2 had developed hematomas. Among patients who underwent TEP 2 had seroma, 1 had port site infection within 30th postoperative day. There was no case of mesh related infection. We didn’t have any case of recurrence post repair in the given follow up duration, At 3 weeks follow up Quality Of Life Using Carolina Comfort Scale Score was mean CCSS of 35.476 for Laparoscopic methods (TAPP & TEP) and mean CCSS of 58.611 for Open method (Lichtenstein) with a significant statistical p value of < .001. Out of 60 patients, 10 patients abstained from sexual activity due to personal/religious reasons. Out of remaining 50 patients who were sexually active within 3 months prior to surgery, 8 patients were not satisfied because of pain and discomfort during such activity. Rest 42 patients were satisfied with their sexual activity. At 24 hour post-surgery mean VAS score for laparoscopic approach was 4.3095 and for open were 5.0556. Post 1 week mean VAS score for laparoscopic approach was 2.3333 and for open was 3.6667. At 3 weeks post-surgery mean VAS score for laparoscopic method was 0.9048 and for open method was 2.4444. At 3 months follow up no patient had pain from laparoscopic group while mean VAS score for open procedure was 0.7778. Post 3 months all 60 patients were pain free.
Conclusion: We recommend Visual analogue scale for assessment of pain and Carolina comfort scale for assessment of quality of life in inguinal hernia mesh repairs.