Evaluation of Quality of Life After Incisional Hernia Repair Using Condition-specific Scales and Risk Factors

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To the Editor:
I read the recent article titled “Quality-of-life and Surgical Outcome 1 Year After Open and Laparoscopic Incisional Hernia Repair PROLOVE: A Randomized Controlled Trial” by Rogmark et al1 published online in Annals of Surgery with great interest. The authors evaluated the quality of life (QoL), predictors for outcome, including recurrence and reoperation rates during the first postoperative year. They have reported that they did not detect any difference between laparoscopic and open incisional hernia surgery concerning restoration of QoL, reoperation, or recurrence rate after 1 year. They showed that restoring the function of the abdominal wall could increase the patient's QoL and reduce abdominal wall complaints. They have also recommended Short Form-36 for capturing changes in QoL after incisional hernia surgery.
I would like to thank the authors for their well-designed and pioneering study. However, I need clarification from the authors on a few topics.
Short Form-36 is a commonly used generic scale, which is used to evaluate the QoL.2 The authors used this scale for the evaluation. But like the comments of Burney et al,3 as a surgeon, I believe that using both a generic and condition-specific scale would be more valuable in showing the outcomes of a surgical practice. It needs to be considered whether Short Form-36 has been used and showed physical function, social function, physical role, emotional role, mental health, energy, pain, and general perceptions with validity and reliability for years.2 I especially believe that for the evaluation and specifying the recovery in the function of abdominal wall after hernia repair, the condition-specific scale would be more advantageous. I have also wondered about what the results would be if the authors used a condition-specific scale such as Hernia-related Quality-of-Life Survey, which was defined by Krpata et al4 with validity and reliability. If it is possible, the knowledge of comparison between generic and condition-specific scales would be beneficial.
Another point that I would like to ask is about the analysis of the risk factors of abdominal wall hernia in different patient demographic groups, such as pregnancy, heavy lifting, obesity, family history of hernias, previous hernia repair, connective tissue disorders, abdominal wall fibrosis, chronic obstructive pulmonary disease, peritoneal dialysis, coughing, and ascites.5–8 The authors reported and analyzed age, American Society of Anesthesiologists physical status classification, smoking habits, body mass index, and properties of the previous hernia repair. But some of the conditions that I have mentioned above were not declared. Although the study did not focus on the identification of risk factors, the evaluation of them in light of the QoL scale would be interesting.
Overall, this is a well-written randomized controlled trial regarding an important clinical problem. Clarifying above concerns would provide useful and valuable data to the readers.
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