Abdominal wall reconstruction (AWR) for post-trauma laparotomy ventral hernia and follow-up assessment of functional quality of life (QOL): experience of a level-1 trauma centre in India

D K Bagaria; S Gupta; S Pandey; N Choudhary; P Priyadarshini; A Kumar; J Alam; B Mishra; S Sagar; S Kumar; A Gupta

doi:10.1007/s10029-024-02978-1

Abdominal wall reconstruction (AWR) for post-trauma laparotomy ventral hernia and follow-up assessment of functional quality of life (QOL): experience of a level-1 trauma centre in India

Hernia. 2024 Feb 23. doi: 10.1007/s10029-024-02978-1. Online ahead of print.

Authors

D K Bagaria¹, S Gupta¹, S Pandey², N Choudhary³, P Priyadarshini¹, A Kumar¹, J Alam¹, B Mishra¹, S Sagar¹, S Kumar¹, A Gupta¹

Affiliations

¹ Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
² Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
³ Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. narendra3483@gmail.com.

PMID: 38388814
DOI: 10.1007/s10029-024-02978-1

Abstract

Purpose: The aim of this study was to examine the postoperative outcomes and follow-up QOL of patients after AWR at a level-1 trauma centre in India.

Methods: The study cohort included AWR patients treated between January 2011 and July 2022. The Activities Assessment Scale (AAS) was used to measure QOL, and the Ventral Hernia Recurrence Inventory (VHRI) was used to determine the occurrence of recurrence. In patients suspected of having recurrence, thorough clinical examination and relevant imaging were performed to confirm or rule out recurrence.

Results: Out of 89 patients, 35 patients whose complete perioperative and follow-up data were available were enrolled. The mean age of the patients was 28 (SD, 9) years. The mean defect size was 14. 9 (SD, 7) cm. The mean time from laparotomy to AWR surgery was 21 months. During the postoperative course, 37% of patients developed complications, such as SSI and seroma. The mean follow-up time was 53 (SD, 43) months. Upon comparing procedures involving the mesh placed in the sublay position with procedures involving the mesh placed in other positions, no statistically significant difference in the recurrence rate (one in each group, p = 0.99), surgical complication rate (33% v/s 66%, p = 0.6), or mean AAS QOL score (94.7 v/s 98, p = 0.4) was observed. The specificity of the VHRI for diagnosing recurrence was 79%.

Conclusion: Overall, the recurrence rate was low in these patients despite the presence of large hernia defects. Long-term QOL was not affected by the specific procedure used. Timely planning and execution are more important than the specific repair approach for post-trauma laparotomy ventral hernia.

Keywords: Abdominal wall reconstruction; Patient-reported outcomes; Trauma; Ventral hernia.