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Fumihiko Fujita, MD; Brian Lahmann, MD; Koji Otsuka, MD; Sergey Lyass, MD; Jonathan R. Hiatt, MD; Edward H. Phillips, MD

Arch Surg. 2004;139:596-600.

Hypothesis  Subjective experiences can be quantified by visual analog scale (VAS) scoring to improve comparison of surgical techniques.

Design  Prospective collection of outcome data by interview of patients at 1 day and 1 week following nonrandomized elective hernia repair by a single surgical group between May 1998 and April 2003.

Setting  Cedars-Sinai Medical Center, Los Angeles, Calif.

Patients  A total of 253 patients (239 men; mean age, 59 years) underwent repair by laparoscopic (n = 110, 105 bilateral, 92 total extraperitoneal, and 18 transabdominal preperitoneal) or tension-free open (n = 143, 133 unilateral) approach. Laparoscopic patients were significantly younger (52.0 vs 63.8 years, P<.001).

Main Outcome Measures  Subjective measures included VAS scores (1-10, 1 indicates best) for pain at 1 day and 1 week postoperatively and overall satisfaction at 1 week. Objective measures included quantity and days of analgesic use and days before return to regular activities, including work and driving. Results were also compared by patient age (Spearman analysis).

Results  Satisfaction was high for both procedures; the laparoscopic procedure was superior only for return to work and driving. Spearman analysis showed a significant inverse relation between age and first-day pain (r= –0.15, P= .01), independent of operative approach. Because laparoscopic patients were younger, patients younger than 65 years were analyzed separately; laparoscopic patients had significantly less first-day pain (5.44 vs 6.30, P= .02).

Conclusions  Pain following hernia repair was age dependent. Following laparoscopic repair, patients had lower first-day pain scores in younger patients and earlier return to normal activities in all patients. Satisfaction was similar for both approaches. Subjective experiences can be quantified, compared to detect subtle differences in outcome for competing surgical techniques, and used to counsel patients before operation, with the goal of improving satisfaction.

From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.

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