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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 108-111

Quality of life of patients with hernia and comparison after its repair


1 Dow University of Health and Sciences, Karachi, Pakistan
2 Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
3 Jinnah Sindh Medical University, Karachi, Pakistan

Date of Web Publication23-May-2019

Correspondence Address:
Farah Ahmed
DUHS, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_45_17

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  Abstract 


Background: Hernia is quite common in Pakistan. Hernia repair techniques have been of various types and have improved over the period to achieve best repair with minimal complications. Hernia repair technique such as the laparoscopic hernia repair is widely used in Pakistan and has superiority over open surgery due to short hospital stay, better cosmetic results, less postoperative pain, and less chance of wound infection. The quality of life of patients postoperatively, has thus been improving now. Methodology: The investigators interviewed the participants themselves. A total of 56 male patients aged 33.5 ± 10 years who had undergone hernia repair surgeries preoperatively and 3 months after surgery agreed to participate in the study. The questionnaire to evaluate patients' preoperatively and postoperatively had 13 questions regarding the effect of abdominal pain due to hernia on daily activities, religious activities, and impact on their health and mood. Likert scale was used to assess the difference in the quality of life of the patients and SPSS version 24 was used to analyze the data. Results: Response rate was 93.33% and the mean age is 33.5 ± 10 years. It was found out that the quality of life of patients improved after surgery so significantly that around 64.48% of people who had stopped doing work-related tasks before surgery due to hernia were then able to carry out work related tasks (87.03%). The quantity of patients with abdominal pain also decreased from 83.3% to 33.32%. Overall, the mood of the patients remained better to such an extent that before surgery, only 25.91% people could carry out daily tasks with minimal irritation but after surgery, 92.59% people started feeling better than before. Conclusion: Abdominal wall surgeries have improved the quality of life of the patients. Thus, the patients should be counseled to get their abdominal wall hernia corrected as soon as possible to lead a good quality and healthy life. Newer advanced techniques have emerged which has led to fewer complications and short hospital stay.

Keywords: Hernia, hernia complications, hernia repair, quality of life


How to cite this article:
Ahmed F, Memon MK, Memon S, Haider SA. Quality of life of patients with hernia and comparison after its repair. CHRISMED J Health Res 2019;6:108-11

How to cite this URL:
Ahmed F, Memon MK, Memon S, Haider SA. Quality of life of patients with hernia and comparison after its repair. CHRISMED J Health Res [serial online] 2019 [cited 2019 Oct 17];6:108-11. Available from: http://www.cjhr.org/text.asp?2019/6/2/108/239586




  Introduction Top


Hernia is an out-pocketing of a viscus or a tissue through an acquired or congenital area of weakness or defect. The term “abdominal hernia” is associated specifically with femoral, inguinal, and umbilical hernias. Abdominal hernias are further classified into abdominal wall hernias (umbilical, epigastric, ventral, and incisional) and groin hernias (femoral and inguinal). About 75% of all abdominal hernias are inguinal. Incisional hernias comprise another 10%–15%. Obturator and other rare hernias account for the remaining 10%–15%.[1] Ascites, liver disease, diabetes, obesity, and primary suture repair without mesh are associated with increased hernia recurrence rates.[2] Hernias are usually asymptomatic but can cause symptoms when they get strangulated or incarcerated.

There are two hernia repair approaches; laparoscopic and open surgery. Numerous studies have suggested that Laparoscopic Hernia Repair is a safer alternative to the Open hernia Repair because it offers less postoperative pain, a shorter hospital stay, less wound complications, and better cosmetic results.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] However, Laparoscopic Hernia is associated with higher occurrence of seroma;[4] nevertheless, this technique is widely being practiced throughout the world.

Previously, only hernioraphy in which the defect was repaired by stitching the healthy ends of a tissue, but now, hernioplasty is done, in which a mesh is used in the repair, which has reduced the risk of postoperative recurrence and incisional hernia to 85% in patients undergoing elective/midline laparotomy closure.[9] Hence, prophylactic mesh placement is now recommended in high risk patients.[10]

There is little, if any, prior research regarding the quality of life of patients with hernia repair surgeries in Pakistan. Hence, this study is based on assessing the quality of life of patients before and 3 months after surgery.
Figure 1: Quality of life of patients with hernia and comparison after its repair

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  Methodology Top


A cross-sectional study design was used to study the quality of life of patient with hernia repair. Sample size was calculated using figures from a similar study[14] and it came out to be 60.

A nonprobability convenient sampling technique was used to select the participants. The available population at the time of survey, fulfilling the inclusion criteria, were interviewed according to the designed questionnaire.

This study was conducted in patients who had undergone anterior abdominal wall correction from Civil Hospital Karachi, Pakistan.

The patients who consented to participate were asked questions according to the questionnaire containing 13 questions preoperatively. Then, they were approached after 3 months through telephonic contact and were asked the same questions. The questions included in the questionnaire were related to the importance of abdominal wall on general well-being of the patient and the quality of life preoperatively and postoperatively. The questionnaire included options in a six-level Likert scale (Likert items: Strongly agree, moderately agree, slightly agree, slightly disagree, moderately disagree, and strongly disagree). Descriptive statistics of sociodemographic variables and all other data is presented as frequency percentages. Data were entered twice, by 2 different investigators of team, to check any missing variables. SPSS version 24 was used.

Informed consent was sought from all participants. The participant in no way was subjected to undue discomfort. They were informed about the aims and objectives of the study. Participants were assured that the data would not be disclosed on the individual basis and that the data will be used in aggregate for research purpose only.


  Results Top


Out of 60 people who had undergone anterior abdominal wall hernia repair surgery, 56 people consented to participate in the survey, thus the response rate was 93.33%. All the participants belonged to the male gender. The mean age of the respondents was 33.5 ± 10 years.

Preoperative assessment of quality of life

Around 66.66% of the respondents strongly believed that their abdominal wall has a major impact on their health, 25.92% agreed and 7.4% disagreed to this question. Approximately 50% of respondents strongly believed that their abdominal wall causes them pain, whereas 33.3% agreed and the remaining 16.66% respondents disagreed with this. Majority (59.25%) strongly agreed to the statement that their abdominal wall interferes with heavy physical exercise (e.g. lefting weight) while 18.51 % agreed and another 22.15% disagreed. However, a lesser percentage of participants 42.59% were in strong agreement to the statement that the abdominal wall interferes with moderate exercise, while others (42.58%) agreed to moderate and slight extent, while the rest (14.8%) disagreed to this. Upon asking, if they feel like their abdominal wall interferes in walking/climbing the stairs, most of the respondents (85.17%) strongly agreed and 12.95% disagreed. About 46.29% people strongly agreed to the fact that their abdominal wall hampered religious activities, while 5.55% moderately and slightly agreed to this and 48.11% disagreed to this fact.

Only 18.51% participants strongly agreed that they often stayed home because of their abdominal wall problem, 14.8% agreed to this; however, 66.66% stated that they did not stay home. For more than a half percentage of people (55%), abdominal wall strongly hampered travelling; however, 18.51% of people agreed to this and others (49.96%) disagreed to this.

We categorized the next two questions into problems faced during household work and problems faced during work-/job-related tasks due to abdominal wall. Nearly 18.51% respondents strongly believed that they performed less household work in contrast to 64.48% who performed less work-/job-related tasks. Same percentage of respondents (9.25%) slightly and moderately agreed to feeling of difficulty in household work and work/job tasks. However, majority (59.25%) of the men disagreed that they felt difficulty in performing household work due to abdominal wall in relation to 25.91% who felt no difficulty in performing work-/job-related tasks.

The results showed that majority of the people strongly agreed to the fact that abdominal wall had been causing some discomfort, 11.1% ticked the option “moderately/slightly agree” and the same percentage of respondents ticked the option “slightly/moderately disagree.” Abdominal wall discomfort had been affecting the mood of the respondents as shown by the results. Statistically, 62.9% of people strongly agreed that abdominal wall issues adversely affected their mood while 11.1% agreed and 25.91% disagreed to this fact. Around, 38.88% of participants strongly believed that their sexual life had disturbed due abdominal wall problems, 9.25% moderately and slightly agreed; nevertheless, 51.81% disagreed to this factor.

Postoperative assessment of quality of life

After undergoing abdominal wall surgery, the patients were asked to reply the same questionnaire after about 3 months. The results varied markedly after abdominal wall correction. The results showed that the quality of life in patients after hernia repair has improved.

About 77.7% of respondents disagreed with the fact that their abdominal wall now has a major impact on their health status, whereas 22.16% still felt that their abdominal wall has a major impact on their health. The results showed that the surgery had decreased their pain to such an extent that around 66.66% of people did not feel pain in the abdominal wall after surgery; in contrast to 33.32% who still felt that their abdominal wall was painful. It was important to note that most of the respondents (75.92%) felt that their abdominal wall did not interfere when doing heavy physical exercise while only 24.05% of people still felt abdominal discomfort. Moreover, abdominal wall correction surgeries also significantly reduced the pain in the abdomen during moderate exercise by 77.7% and walking/climbing the stairs by 92.95%, whereas 22.3% and 7.05% respondents still felt abdominal discomfort during moderate physical activities and walking/climbing the stairs, respectively. The participants of this research (96.29%) were able to perform religious activities efficiently and only a minority (3.7%) of the participants still felt that abdominal wall hampered their religious activities.

The results of this study also showed that the patient stopped staying home for long period and 96.29% of people carried out normal activities without being restricted to home, but a minority of patients (3.7%) still stayed at home due to abdominal pain. Moreover, 96.29% of respondents felt no difficulty in travelling.

The respondents felt that their abdominal wall did not interfere in performing housework (96.29%) and in performing work-related tasks (87.03%).

Furthermore, majority 83.32% of the respondents disagreed to the fact that their abdominal wall caused some discomfort, 92.59% of the respondents disagreed to the fact that the abdominal wall issues were adversely affecting their mood, and 92.95% of people had no sexual problems after 3 months of surgery.


  Discussion Top


The questionnaire used was easy and understandable to such an extent that only 4 people out of 60 did not consent to participate in the study; thus, the response rate of 93.33%. We included male patients only in our study because males are more prone to develop hernia than females.[15],[16],[17] Likert scale (also called summative scale) was used to assess the level of improvement of the quality of life in hernia repair patients. However, there are certain limitations of this scale. This scale can produce biased opinions among the respondents. Central tendency biases are the ones, in which respondents avoid using extreme response categories. Acquiescence biases are the ones in which the respondents agree with the statements as presented. Social desirability biases are the ones in which they try to portray themselves in a more favorable light. Hence, to avoid such biases, we made sure to include the equal number of positive and negative statements.

We evaluated the quality of life of patients before and after surgery. The patients who had undergone inguinal surgery were included in this study. Previously, open surgery was done to correct hernia; but now, laparoscopic techniques are gaining more popularity due to less postoperative pain, a shorter hospital stay, less wound complications, and better cosmetic results.[3],[4],[5],[6],[7],[8],[11],[12] Furthermore, different types of meshes are now used for better postoperative results, polypropylene being the most widely used mesh material for hernia repair because it shows five times better stretch and tensile strength than the maximal physiological stress.[13]

Hernia repair is one of the most common surgical procedures done worldwide. Despite this fact, less previous work is available in Pakistan related to the quality of life in patients undergoing hernia repair. Our study showed almost the same results as a similar study conducted in Northern Ireland. The health perception, physical mobility (mild, moderate, heavy), social functions (job, household work, religious and sexual activities), pain perception, mental health and mood, and energy of the individuals showed significant difference pre- and postoperatively, showing betterment of the quality of life postoperatively.[18] There are other such studies that support our results.[19],[20]

The results showed that the quality of life in patients undergoing hernia repair had significantly improved. Their mood, life-style, and daily activities showed improvement. Hernia is usually asymptomatic but becomes symptomatic only when it gets strangulated or incarcerated. Hence, people usually do not go for urgent hernia repair until when hernia starts interfering with their daily life activities and when they are unable to perform even simple tasks.

Therefore, early hernia repair should be recommended. Our study demonstrates on how surgery had remarkable effect on the quality of the activities of daily living, that is, activities of daily lives of our respondents. The prognosis of hernia repair is very good. These advanced techniques not only reduce hospital stay time but also have fewer complications.


  Conclusion Top


Majority of the people were satisfied with the surgery. The drastic improvement in the results show that the patients should be suggested to get their abdominal wall correction done soonest after they are diagnosed with hernia so that their quality of life can improve along with the disease cure. This is consistent with improved surgical techniques for hernia repair such as laparoscopic technique and usage of mesh. Moreover, patients should be counseled about the potential complications of hernia such as obstruction and strangulation of the bowels if they do not get their hernia repair surgery done.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Parswa. MSD Manual Professional Edition. Hernia: Abdominal Wall Hernias Inguinal, Umbilical, & Femoral – Gastrointestinal Disorders – MSD Manual Professional Edition.  Back to cited text no. 1
    
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Kapischke M, Schulz T, Schipper T, Tensfeldt J, Caliebe A. Open versus laparoscopic incisional hernia repair: Something different from a meta-analysis. Surg Endosc 2008;22:2251-60.  Back to cited text no. 4
    
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Yavuz N, Ipek T, As A, Kapan M, Eyuboglu E, Erguney S. Laparoscopic repair of ventral and incisional hernias: Our experience in 150 patients. J Laparoendosc Adv Surg Tech A 2005;15:601-5.  Back to cited text no. 6
    
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Claus CM, Loureiro MP, Dimbarre D, Cury AM, Campos AC, Coelho JC. Laparoscopic incisional hernioplasty: Experience of 45 cases. ABCD Arq Bras Cir Dig 2011;24:121-5.  Back to cited text no. 7
    
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Borab ZM, Shakir S, Lanni MA, Tecce MG, MacDonald J, Hope WW, et al. Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 2017;161:1149-63.  Back to cited text no. 9
    
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Wang XC, Zhang D, Yang ZX, Gan JX, Yin LN. Mesh reinforcement for the prevention of incisional hernia formation: A systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017;209:17-29.  Back to cited text no. 10
    
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Kumar D, Khan H, Qureshi MS. Outcome of four years experience in laparoscopic ventral hernia repair. Pak J Med Sci 2015;31:987-90.  Back to cited text no. 11
    
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Stoker DL, Spigelhalter DJ, Singh R, Wellwood J. Laparoscopic versus open hernia repair; randomised prospective trial. Lancet 1994;343:1243-5.  Back to cited text no. 12
    
13.
Ladurner R, Chiapponi C, Linhuber Q, Mussack T. Long term outcome and quality of life after open incisional hernia repair – Light versus heavy weight meshes. BMC Surg 2011;11:25.  Back to cited text no. 13
    
14.
Abdalla RZ, Garcia RB, Said DF, Abdalla BM. Quality of life of in patients submitted to anterior abdominal wall laparoscopic hernioplasty. Arq Bras Cir Dig 2014;27:30-3.  Back to cited text no. 14
    
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Jones ME, Swerdlow AJ, Griffith M, Goldacre MJ. Risk of congenital inguinal hernia in siblings: A record linkage study. Paediatr Perinat Epidemiol 1998;12:288-96.  Back to cited text no. 15
    
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Khattak S, Ali MS. Groin hernias. J Postgrad Med Inst 2004;18:457-62.  Back to cited text no. 16
    
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Velanovich V, Shadduck P, Khaitan L, Morton J, Maupin G, Traverso LW, et al. Analysis of the SAGES outcomes initiative groin hernia database. Surg Endosc 2006;20:191-8.  Back to cited text no. 17
    
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Lawrence K, McWhinnie D, Jenkinson C, Coulter A. Quality of life in patients undergoing inguinal hernia repair. Ann R Coll Surg Engl 1997;79:40-5.  Back to cited text no. 18
    
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Jensen KK. Recovery after abdominal wall reconstruction. Dan Med J 2017;64.  Back to cited text no. 19
    
20.
Staerkle RF, Vuille-Dit-Bille RN, Fink L, Soll C, Villiger P. Chronic pain and quality of life after inguinal hernia repair using the COMI-hernia score. Langenbecks Arch Surg 2017.  Back to cited text no. 20
    


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