Evaluation of post operative pain and seroma in patients of ventral hernia repair

Introduction: Ventral hernia repair is a common surgical procedure. The incidence ranges from 2% to 20% and varies greatly from one series to another. Most ventral hernias require some sort of repair which may be done laparoscopically or by open method. Laparoscopic surgery has often been considered as less painful and with lower incidence of seroma formation than similar open surgery, but this is not the case in ventral hernia repair. The use of titanium tacks for mesh fixation in LVHR is the most likely explanation of postoperative pain as this fixation technique can cause bleeding, hematoma, nerve injury The objective this study is to evaluate occurrence of pain and seroma in patients with ventral hernia repair by open or laparoscopic method.
Methods: This prospective study was conducted on 200 patients between August 2015 to July 2016 who underwent Open or Laparoscopic ventral hernia repair at North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi. The sample size was calculated using the formula for proportions with 95% confidence level P = 0.5. Outcome is based on patient self-reported registrations using Visual Analogue Scales at 6 hours after hernia repair, Day1, Day2, Day 3, at discharge. Seroma formation measured on day 2 postoperatively with transabdominal ultrasound scan (USG).
Results: Of the 173 patients in open group, 82 (47.39%) patients had incisional hernia. Making it the most common type of hernia. Of 27 patients in laparoscopy group, 11 (40.74%) had umbilical hernia, making it the most common VH. The overall complication rate in open group was 44.08% while in laparoscopy group it is 22.2%. All patients had post-operative pain till 6 hrs. after surgery but the incidence of pain in LVH repair decreased significantly after day 1 as compared to open repair. Postoperative seroma too was more common in open group contributing to 27.74% compared to laparoscopy group which accounts to 14.81%. Other complications such as wound infection and post-operative ileus too were more in open group (30.05%) compared to laparoscopy group (22.2 %.)
Conclusion: Laparoscopic ventral hernia repair has shown more promising results and has a clear advantage over open repair in regard with reduced post-operative pain, decreased post-operative complications, reduced length of hospital stay and less seroma formation. Hence, laparoscopic ventral hernia repair is a safe and feasible alternative to open repair.