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Purpose: In the past we have developed and validated the hernia-specific quality of life assessment instrument, HERQL, for groin hernias. In current study we evaluated the conceptual structure and validated HERQL for abdominal wall hernias.Methods: Subjective quality-of-life perceptions from abdominal wall hernia patients were assessed. Clinical responsiveness was evaluated comparing treatment naïve with follow-up hernia patients. Measurement invariance between groin and abdominal wall hernias was approached with structural equation modeling (SEM). Subgroup comparisons were conducted between primary ventral and incisional hernias, as well as the presence of co-morbidity, hernia incarceration, surgical complications, and recurrent abdominal wall hernias.Results: A total of 775 HERQL assessments, including 167 from abdominal wall hernias, were successfully performed. Cronbach's alpha coefficients for the summative pain, worse symptoms for treatment-naïve patients, and improving summative pain scores across the pre-operative, immediately post-operative, and post-operative 3-month assessments indicating clinical responsiveness were observed and comparable between groin and abdominal wall hernias. Configural invariance was evidenced by that the same model held true for both types of hernias with multi-group SEM, while mean structure exploration showed that abdominal wall hernia patients reported less latent summative pain (- 0.535, p < 0.0001) but worse latent quality-of-life score (0.207, p < 0.0001). Patients with peri-operative complications suffered from worse pain during mild activities (2.7 versus 1.5, p = 0.01), and patients with recurrent hernias reported compromised global health/quality of life (2 versus 1.6, p = 0.001).Conclusions: The study successfully validated and extended the clinical applicability of HERQL across distinct types of hernias. Measurement invariance was ascertained and the same HERQL construct could be administered for both abdominal wall and groin hernias in Taiwan. [ABSTRACT FROM AUTHOR]

This study reports the association between parental uncertainty and characteristics of 123 parent–child dyads prior to the child’s herniorrhaphy. A cross-sectional study design and Mishel’s Parents’ Perception of Uncertainty Scale (PPUS) were used. Parent participants were married (98%), had a university degree (45%), identified with a religion (77%), and worked (69%). More boys (76%) than girls (23%) underwent herniorrhaphy (average age = 2.26 years); 60% were the first-born child and 25% were premature. More children presented with unilateral (63.4%; right = 44.7%, left = 18.7%) than bilateral (36.6%) hernias and most were primary (98%). Overall uncertainty was perceived as moderate and ambiguity had the highest score. Religion, birth order (first child), and hernia site (bilateral) explained 20.6% of total variance of uncertainty. Providing information about postoperative symptom and pain management is important for all parents, particularly for parents identified with a religion and whose first-born child had bilateral hernias. [ABSTRACT FROM AUTHOR]

Background: To identify the rate of and risk factors for contralateral inguinal hernia (CIH) after unilateral inguinal hernia repair in adult male patients.Methods: This retrospective cohort study identified from the Taiwan National Health Insurance Research Database (NHIRD). Information on all adult patients who underwent primary unilateral inguinal hernia repair without any other operation was collected using ICD-9 diagnostic and procedure codes. The exclusion criteria were laparoscopic hernia repair, non-primary repair, complicated hernia, other combined procedures, female and undetermined gender.Results: A total of 170,492 adult male patients were included, with a median follow-up of 87 months. The overall CIH rate was 10.5%, with a median time of 48 months to a subsequent hernia operation. The 1-year, 2-year, 3-year and 5-year-recurrent rate was 2.6, 3, 4.3, and 6.7% respectively. Further, 3.7% patients who underwent CIH repair had a complicated inguinal hernia. Multivariate analysis demonstrated that age > 45 y, direct hernia, cirrhosis (HR = 1.564), severe liver disease (HR = 1.663), prostate disease (HR = 1.178), congestive heart failure (HR = 1.138), and history of malignancy (HR = 1.116) had a significantly higher risk of CIH repair.Conclusions: Among adult male patients undergoing long-term follow-up, we identified several significant risk factors for CIH repair. If these risk factors are presented, the surgeon should inform the following risk of CIH repair to patients so that it can be repaired as soon as possible. [ABSTRACT FROM AUTHOR]

Background: With the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications. Study design: A novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well. Results: A total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach’s alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL. Conclusions: This study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity. [ABSTRACT FROM AUTHOR]

Background: Previous prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD). Methods: Between 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance. Results: A total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH. Conclusions: After 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients. [ABSTRACT FROM AUTHOR]

Purpose: This study uses a national database to evaluate the incidence of inguinal hernia and associated risk factors of incarcerated hernia in children from birth to 15 years of age.Methods: The study selected children born from 1997 to 2005 from a randomly selected cohort of 1,000,000 from an insured population of 23 million. We regarded children that were classified with code 550 and hernia surgery in accordance to the International Classification of Diseases, 9th Revision, as having inguinal hernia. We used the 2 chi-square test and logistic regression modeling for statistical analyses.Results: In total, 79,794 children (41,767 male and 38,027 female) were enrolled in the study. The cumulative incidence of inguinal hernia in males and females from birth to 15 years old were 6.62 and 0.74 %, respectively (p < 0.01). The peak incidence of inguinal hernia was at 0 years of age for males and 5 years of age for females. The ratio of unilateral vs. bilateral repair was 5.54:1. Females tend to have more bilateral inguinal hernia than males (25.4 vs. 12.9 %, p < 0.01). Incarcerated hernia occurred in 4.19 % children with inguinal hernia without significant gender discrepancy. Approximately 40 % of incarcerated hernia underwent hernia repair immediately after visiting the emergent department. In patients who presented with reducible hernia, we did not find significant correlation between waiting time to hernia repair and occurrence of incarceration.Conclusions: The cumulative incidence of inguinal hernia from birth to 15 years of age was 6.62 and 0.74 % in males and females, respectively. Incarceration was not related to prematurity or the waiting time for surgery. [ABSTRACT FROM AUTHOR]