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Revisiting HERQL, the hernia-specific quality-of-life assessment instrument, to extend the clinical applicability for abdominal wall hernias

  • C.-C. Huang
  • H.-H. Lien
  • J.-U. Wong
  • T.-F. Ho
  • W.-P. Chang
  • C.-S. HunagEmail author
Original Article
Part of the following topical collections:
  1. Quality Control



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.


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.


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).


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.


Abdominal wall hernia Quality of life Chronic pain HERQL Validation study Structural equation modeling 



The work was supported in part by MOST-103-2314-B-281-004-MY2, CGH-MR-A10510, and MOST-107-2314-B-030-007-MY3. All authors declare that they have no competing interests. This manuscript contained materials presented at the 14th Asia Pacific Hernia Society Conference Annual Meeting held during Nov-29 and Dec-1, Dubai, UAE.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been reviewed and approved by the Institute Review Board of Cathay General Hospital under the access number CGH-P102069 and CGH-P104116.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10029_2019_2066_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)
10029_2019_2066_MOESM2_ESM.xlsx (21 kb)
Supplementary material 2 (XLSX 21 kb)


  1. 1.
    Huang CC, Lien HH, Huang CS (2013) Long-term follow-up of laparoscopic incisional and ventral hernia repairs. J Laparoendosc Adv Surg Tech A 23:199–203CrossRefGoogle Scholar
  2. 2.
    Huang CC, Tai FC, Chou TH, Lien HH, Jeng JY, Ho TF, Huang CS (2017) Quality of life of inguinal hernia patients in Taiwan: the application of the hernia-specific quality of life assessment instrument. PLoS One 12:e0183138CrossRefGoogle Scholar
  3. 3.
    Bollen KA (1989) Structural equations with latent variables. Wiley, New YorkCrossRefGoogle Scholar
  4. 4.
    Byrne BM, Shavelson RJ, Muthén B (1989) Testing for the equivalence of factor covariance and mean structures: the issue of partial measurement invariance. Psychol Bull 105:456–466CrossRefGoogle Scholar
  5. 5.
    Gu F, Wu W (2011) Using SAS PROC TCALIS for multigroup structural equation modelling with mean structures. Br J Math Stat Psychol 64:516–537CrossRefGoogle Scholar
  6. 6.
    Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736CrossRefGoogle Scholar
  7. 7.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334CrossRefGoogle Scholar
  8. 8.
    Huang CC, Lien HH, Tu SH, Huang CS, Jeng JY, Chao HL, Sun HL, Chie WC (2010) Quality of life in Taiwanese breast cancer survivors with breast-conserving therapy. J Formos Med Assoc 109:493–502CrossRefGoogle Scholar
  9. 9.
    Conze J, Binnebösel M, Junge K, Schumpelick V (2010) Incisional hernia—how do I do it? Standard surgical approach. Chirurg 81:192–200CrossRefGoogle Scholar
  10. 10.
    Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554CrossRefGoogle Scholar
  11. 11.
    Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Treatment of large eventrations. new therapeutic indications apropos of 322 cases. Chirurgie 111:215–225PubMedGoogle Scholar
  12. 12.
    Wantz GE (1991) Incisional hernioplasty with mersilene. Surg Gynecol Obstet 172:129–137Google Scholar
  13. 13.
    Campbell DT, Fiske DW (1959) Convergent and discriminant validation by the multitrait-multimethod matrix. Psychol Bull 56:81–105CrossRefGoogle Scholar
  14. 14.
    Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644CrossRefGoogle Scholar
  15. 15.
    Hope WW, Lincourt AE, Newcomb WL, Schmelzer TM, Kercher KW, Heniford BT (2008) Comparing quality-of-life outcomes in symptomatic patients undergoing laparoscopic or open ventral hernia repair. J Laparoendosc Adv Surg Tech A 18:567–571CrossRefGoogle Scholar
  16. 16.
    Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B et al (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642CrossRefGoogle Scholar
  17. 17.
    Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–250CrossRefGoogle Scholar
  18. 18.
    Chung L, O’Dwyer PJ (2014) Pain and its effects on physical activity and quality of life before operation in patients undergoing elective inguinal and ventral hernia repair. Am J Surg 208:406–411CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • C.-C. Huang
    • 1
    • 2
  • H.-H. Lien
    • 2
    • 3
  • J.-U. Wong
    • 4
  • T.-F. Ho
    • 5
  • W.-P. Chang
    • 6
  • C.-S. Hunag
    • 3
    • 7
    Email author
  1. 1.Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.School of Medicine, College of MedicineFu-Jen Catholic UniversityNew TaipeiTaiwan
  3. 3.Department of SurgeryCathay General HospitalTaipeiTaiwan
  4. 4.Department of SurgeryFu-Jen Catholic University HospitalNew TaipeiTaiwan
  5. 5.Department of SurgeryCathay General Hospital SijhihNew TaipeiTaiwan
  6. 6.School of Health Care AdministrationTaipei Medical UniversityTaipeiTaiwan
  7. 7.School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan

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