Long-term patient-reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review.

PURPOSE: Patient-reported outcome measures (PROMs) have been increasingly accepted to evaluate the quality of surgery. The impact of a hernia on PROMs and the indication for elective ventral hernia mesh repair are poorly researched. The primary objective in this systematic review was to provide evidence for PROM changes at least 3 months after elective ventral hernia mesh repair. Secondarily, a critical appraisal of the study quality was undertaken. METHODS: Ovid MEDLINE, PubMed, Ovid Embase, and CENTRAL were searched (year 2000-May 12, 2019) for studies reporting any of 21 predefined PROMs pre- and ≥ 3 months postoperatively following adult ventral hernia mesh repair. A pre-study defined analysis method was used to assess pre- vs. postoperative PROM changes. Quality assessment was guided by criteria formulated by the National Institutes of Health. RESULTS: The search yielded 11,438 potentially eligible studies of which 24 met the inclusion criteria. Most studies were of poor or moderate quality and one study was of high quality. There was no evidence for a clinically relevant postoperative improvement in any PROM following umbilical hernia repair or medium-sized incisional hernia repair. A clinically relevant postoperative improvement of pain, physical impairment, and social involvement was seen in patients with a large-sized incisional hernia repair and stoma-related complaints in patients with a medium-sized parastomal hernia repair. CONCLUSION: This analysis suggested that a minor subset of PROMs improved in patients undergoing large-sized incisional and medium-sized parastomal hernia repair. High-quality studies are imperative in this extremely often conducted surgical procedure. TRIAL REGISTRATION: The review was registered at PROSPERO (CRD42018096671, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=96671 ).