From the Guidelines
Ventral hernia repair can significantly improve quality of life for patients across all socioeconomic backgrounds, though outcomes may vary based on socioeconomic status (SES) 1.
Key Considerations
- Patients with lower SES often experience delayed care, higher complication rates, and worse post-operative quality of life compared to those with higher SES.
- The choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination (grade 2C recommendation) 1.
- Biological mesh prosthetics are most commonly used in infected fields involving large, complex abdominal wall hernia repairs, and may offer a low-morbidity alternative to prosthetic mesh products in these complex settings, with good results also in immune-compromised patients 1.
Socioeconomic Status and Outcomes
- Socioeconomic disparities can affect access to care, with lower SES patients potentially having less access to laparoscopic repairs, which generally offer faster recovery 1.
- Post-operative care, including pain management and follow-up, can be influenced by socioeconomic status, with lower SES patients potentially facing more challenges in accessing comprehensive care 1.
Surgical Approach and Recovery
- The surgical approach itself (open versus laparoscopic) may be influenced by SES factors, with laparoscopic repairs generally offering faster recovery but potentially being less accessible to lower-income patients 1.
- Recovery timelines vary by procedure type, with most patients returning to light activities within 2-4 weeks and full activities by 6-8 weeks 1.
Addressing Disparities
- Healthcare systems can address SES disparities through programs that provide financial assistance, transportation support, and comprehensive pre- and post-operative education to ensure all patients receive optimal care and achieve the best possible quality of life improvements after ventral hernia repair 1.
Biological Mesh Use
- A recent multicentre large-sized retrospective study compared suture, synthetic mesh, and biologic matrix in contaminated ventral hernia repair, and found that a biologic matrix was associated with a non-significant reduction in both SSI and recurrences 1.
- The use of biological materials in clinical practice has led to innovative methods of treating abdominal wall defects in contaminated surgical fields, although there is still an insufficient level of high-quality evidence on their value 1.
From the Research
Ventral Hernia Repair and Quality of Life
- Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) in patients, as measured by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes) 2.
- The amount of improvement in QOL may be dependent on hernia size and approach, with larger hernias (>6 cm) showing a greater improvement in 8 of 12 components of QOL measured in the HerQLes questionnaire 2.
- Laparoscopic repair at diagnosis is cost-effective compared to open repair at diagnosis, with an incremental cost-effectiveness ratio of $27,700/QALY 3.
Socioeconomic Status and Ventral Hernia Repair
- There is limited information available on the relationship between socioeconomic status and ventral hernia repair quality of life.
- However, studies have shown that patients with lower baseline quality of life are more likely to experience a recurrence following repair, and may have a lower socioeconomic status 4.
Clinical Outcomes and Cost-Effectiveness
- Ventral hernia repair at diagnosis is very cost-effective, with the choice between open and laparoscopic repair depending on surgical costs and postoperative quality of life 3.
- The use of non-woven polypropylene mesh in laparoscopic ventral hernia repair has been shown to have good outcomes with long-term follow-up, and may have benefits in terms of biocompatibility compared to other mesh options 5.
- Laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications, with a recurrence rate of 0% at 50 months of follow-up 6.