Commentary on “Medium-Term Recurrence and Quality of Life Assessment Using the Hernia-Specific Carolinas Comfort Scale Following Laparoscopic Inguinal Hernia Repair”: Asking the Right Questions—Evaluating Outcomes in Hernia Repair

You will not know the answer if you never ask. This old adage is becoming more and more important in evaluating outcomes in hernia repair. Until recently, inguinal hernia repair was deemed a success if the patient had a healed wound without evidence of infection or recurrence on the first postoperative visit. In many cases, this would be the last time you evaluated the patient unless a problem occurred, and if he or she developed a recurrence in the future, the patient would often be seen by another surgeon. When patients returned with pain or discomfort, we often told them that it was related to the surgery and would go away with time as we really had no good way to measure or evaluate pain. Although we as surgeons thought we were doing a great job fixing inguinal hernias, as the recurrence rate was low and major complications were minimal, perhaps we were not asking the right questions.

Jalil et al. ¹ have reported on the medium-term quality of life outcomes of patients undergoing inguinal hernia repair using a laparoscopic transabdominal preperitoneal (TAPP) approach and a validated, hernia-specific questionnaire. Although the reported prevalence of severe or disabling symptoms following TAPP inguinal hernia repair seems to be low, the numbers of patients reporting mild to moderate pain, movement limitations, and sensation of mesh are likely much higher than many of us care to admit.

Although some may argue that it is the use of mesh that is causing an increase in pain and discomfort following inguinal hernia repair, ² it is most likely that until recently we have not had the tools or the desire to evaluate this potential problem. Newer validated hernia quality of life questionnaires such as the Carolinas Comfort Scale ³ and HerQles ⁴ have allowed surgeons to ask our hernia patients the right questions. Although recurrence will always be an important outcome measure for hernia repair, we are now becoming more in tune with the implications of hernia repair on our patient's quality of life. The work by Jalil et al. ¹ and others is a huge first step in evaluating important quality of life outcomes in our hernia patients so that we can quantify the problem and hopefully find ways to impact it in a positive way.