Hernia最新文献

Purpose: The incidence of trocar site hernia (TSH) after bariatric surgery is unclear. This study aims to describe the cumulative incidence of ventral hernia surgery after laparoscopic bariatric surgery in total and by laparoscopic method (LRYGB; Roux-en-Y Gastric Bypass and LSG; Sleeve Gastrectomy).

Methods: This was a register based observational study on patients subjected to laparoscopic bariatric surgery (LRYGB or LSG) in Sweden 2009-2019. The Scandinavian Obesity Surgery Registry (SOReg) was linked to the Swedish National Patient Register (NPR) to obtain instances of ventral hernia surgery. Nearby codes were used as proxies for TSH surgery, since a specific procedure code for TSH surgery is lacking.

Results: In 64 124 patients, mean follow-up was 67 ± 36 months, LRYGB (n = 52 020) 74 ± 34 months and LSG (n = 12 104) 34 ± 22 months. Mean time between bariatric- and ventral hernia surgery was 36 ± 28 months (range 0-129). The five-year cumulative incidence of surgery for ventral hernia was 2.9% (CI 2.8-3.1). The probability of having hernia surgery was significantly higher for LRYGB compared to LSG (Breslow test, p < 0.001), still significant with differences in follow-up time accounted for (p < 0.001).

Conclusion: The incidence of surgery for ventral hernia after laparoscopic bariatric surgery is not negligible in this material covering over a decade of bariatric procedures. Ventral hernia surgery was more common after gastric bypass than after sleeve gastrectomy.

Purpose: Prehabilitation, including smoking cessation, weight loss, and glycemic control, has been shown to improve outcomes in abdominal wall reconstruction (AWR). While many AWR programs have adopted these strategies, it remains unclear how consistently general surgeons (GS) implement prehabilitation in elective AWR.

Methods: An 18-question anonymous survey was distributed via REDCap to GS at two tertiary care institutions with active AWR programs. Surgeons who performed hernia repair but were not members of the AWR programs were questioned. Descriptive statistics compared attitudes, practices, and institutional support across hospitals by surgical volume were performed.

Results: Surveys were sent to 57 GS at Hospital System 1 (HS1) and 27 GS at Hospital System 2 (HS2). Of 84 surveys, 28 GS responded, yielding response rates of 30% for HS1, 48% for HS2, and 33% overall. All respondents agreed that active smoking, obesity, and uncontrolled diabetes negatively impact AWR outcomes. However, less than one-third postpone surgery for smoking cessation (32%), weight loss (29%), HbA1C improvement (32%). Barriers included concern about surgical volume/income (25%), limited perceived support from colleagues (43%) or their institution (53%). Although 57% reported access to prehabilitation resources, only 13% consistently referred patients.

Conclusion: Despite strong evidence, unanimous agreement of its benefits, and active, institutional AWR programs that perform prehabilitation, this practice remains underutilized among general surgeons. Concerns about reduced operative volume, income, and colleague and institutional support are key barriers. Addressing these may increase prehabilitation utilization among GS and ultimately improve outcomes.

Background: Obesity increases the rate of postoperative wound complications for patients undergoing open abdominal wall reconstruction (AWR) and predisposes patients to hernia recurrence. While minimally invasive surgery (MIS) techniques minimize wound morbidity in obese patients, the exact degree to which this occurs remains unknown.

Methods: A prospectively maintained single-institution hernia database was queried for patients undergoing robotic-assisted (rTAR) from 2018 to 2024. Basic demographics, operative characteristics and postoperative outcomes were reviewed. A univariate analysis was performed to compare outcomes for patients with a BMI < 35 kg/m² (low BMI) to those with BMI ≥ 35 kg/m² (high BMI). The primary outcomes were 30-day surgical site infection (SSI) and hernia recurrence.

Results: There were 128 patients: 72 with low BMI and 56 with high BMI. Mean BMI for each group was 28.2±3.6 and 41.5±4.6 kg/m², respectively (p < 0.01). There were more recurrent hernias (8.3% vs. 25.0%, p = 0.01) and larger hernia defects (median(Q1-3)) (101(35-192) vs. 150(98-240) cm², p = 0.01) in the high BMI group. Most patients underwent bilateral TAR (69.4% vs. 73.2%, p = 0.70). There was no difference in SSI rate or (1.4% vs. 0.0%, p = 0.78) or hernia recurrence at 6 months (1.8% vs. 0.0%, p = 0.65). Quality of life outcomes were similar at 3 weeks and 6 months (each p > 0.05).

Conclusion: Despite having more complex hernias, the high and low BMI groups had comparable rates of 30-day SSI and short-term hernia recurrence. rTAR appears to be a safe and effective operation for patients with a BMI ≥ 35 kg/m².

Objectives: To determine the relative efficacy and safety of surgical techniques for parastomal hernia (PH) repair using a Bayesian network meta-analysis (NMA), integrating direct and indirect evidence to generate probabilistic rankings and guide clinical decision-making.

Methods: We conducted a systematic review and Bayesian NMA of 28 studies (1.983) patients) comparing seven PH repair techniques, following PRISMA-NMA guidelines. The primary outcome was parastomal hernia (PH) recurrence; the secondary outcome was cumulative postoperative complications. Random-effects models with a binomial likelihood and a logit link function were used. SUCRA probabilities ranked interventions; node-splitting assessed inconsistency; meta-regression evaluated covariates.

Results: FunnelMesh achieved the highest SUCRA score for recurrence reduction (91.55%), significantly outperforming Keyhole (OR 0.06, 95% CrI: 0.01-0.35) and Repair (OR 0.11, 95% CrI: 0.02-0.55). Sandwich ranked second (80%). For complications, Modified Keyhole (KeyholeM) ranked safest (SUCRA = 91%), with a significantly lower complication risk than Sugarbaker (OR = 0.23; 95% CrI: 0.05-0.94) and Keyhole (OR = 0.22; 95% CrI: 0.04-0.92). Node-splitting revealed inconsistencies in the FunnelMesh comparisons, warranting cautious interpretation. Meta-regression confirmed robustness across stoma type, approach, and follow-up duration.

Conclusions: FunnelMesh and Sandwich offered superior recurrence prevention; KeyholeM provides the optimal balance of low recurrence and minimal complications. The traditional Keyhole technique remained associated with high failure rates, reinforcing current guideline recommendations against its use. These findings provide an evidence-based framework to individualize PH repair strategies based on efficacy and safety trade-offs.

Highlights: Bayesian network meta-analysis comparing all major techniques for parastomal hernia repair. FunnelMesh, Sandwich, and modified Keyhole achieve the best balance of efficacy and safety. Provides an evidence-based framework to guide surgical selection and patient counseling.

Purpose: Mesh reinforcement is generally recommended in ventral hernia repair. This study examined temporal trends in mesh placement in elective ventral hernia repair over the past 18 years to better understand changes in clinical practice, with a secondary focus on trends in surgical approach.

Methods: This study utilized prospectively collected data from the Danish Ventral Hernia Database, covering the period from its inception in 2007 to 2024 in Denmark. Primary and incisional hernias with defect widths < 10 cm were included in the analysis.

Results: A total of 62,963 operations were included, with primary hernias accounting for 76% of cases. Mesh repair has increased over time, particularly for primary ventral hernias, rising from 820 cases (40.9%) in 2007 to 2,300 cases (80.6%) in 2024. Until around 2018, intraperitoneal onlay mesh (IPOM) placement was the most common repair technique for hernia defects > 1 cm. Its use then declined significantly and was surpassed by onlay for defects measuring ≤ 4 cm, followed by preperitoneal and retromuscular mesh placements. For defects > 4 cm, retromuscular placement became dominant (72% for incisional hernias in 2024; 54% for primary hernias). By 2024, the use of IPOM had become minimal across all defect sizes. Over the study period, laparoscopic repairs decreased, while open and robotic approaches increased.

Conclusion: Mesh placement has changed over time, and in the beginning of the 2010s, IPOM was the most commonly used placement, but its use declined and was replaced by extraperitoneal placements, with onlay preferred for small- and medium-sized defects and retromuscular for large defects. By 2024, the use of IPOM had become minimal. These shifts have not followed current evidence and may therefore reflect evolving surgeon preference. Stronger evidence is needed to guide best practices and improve patient outcomes.

Purpose: The aim was to investigate which mesh weight interval was associated with the lowest risk of recurrence for patients with incisional and primary ventral hernias undergoing onlay repair.

Methods: Prospectively collected data were obtained from the Danish Ventral Hernia Database, which was linked to the Danish National Patient Registry and the Danish Civil Registration System to ensure complete follow-up of included patients. Data were gathered from January 1, 2007, to April 18, 2024. Multiple exploratory Cox regressions were performed to determine which mesh weight interval was associated with the lowest risk of reoperation for recurrence.

Results: In total, 10,174 patients were included in the study; of these, 1,966 had incisional hernias and 8,208 had primary ventral hernias, which were considered separately in two different cohorts. For patients with incisional hernias, the mesh weight interval of 50-65 g/m² resulted in the lowest reoperation rate compared with 16-49 g/m² (HR = 1.75 (1.06-2.89), p = 0.028) and with 66-110 g/m² (HR = 2.05 (1.19-3.54), p = 0.009). For patients with primary ventral hernias, meshes weighing > 35 g/m² resulted in the lowest risk of reoperation for recurrence compared with < 35 g/m² (HR = 2.15 (1.38-3.35), p < 0.001).

Conclusion: For open onlay ventral hernia repair, mesh weighing 50-65 g/m² resulted in the lowest risk of recurrence for incisional hernias, while mesh weighing > 35 g/m² resulted in the lowest risk of recurrence for primary ventral hernias.

Background: Seroma formation and recurrence are considered two of the most common complications of inguinal hernia repair especially in minimal invasive approach especially when the defect size is large. Closure of the defect and obliteration of dead space(DCODS) can help mitigate these complications. Robotic surgery helps in closure of the defect because of the ease of suturing. The aim of this study is to evaluate the short-term results of closure of defect in these hernias.

Methods: Retrospective analysis of the data of all patients who underwent total extraperitoneal (TEP)/extended Total extraperitoneal(eTEP) or robotic trans abdominal pre peritoneal (rTAPP) for inguinal hernia repairs in a single tertiary care centre was done in this cohort study. Primary outcome analysed was seroma formation, the secondary outcomes included groin pain, surgical complications, and early hernia recurrence.

Results: A total of 198 hernia repairs were carried out in 136 patients. 132 were male and 4 were female. Of these 32 patients who had undergone a Lichtenstein's repair were excluded. There were 102 rTAPP repairs and 64 TEP/eTEP repairs in all. Mean age was 49.77(SD 17.3)years and mean BMI was 27.52(SD 5.21)kg/m². No DCODS was performed in TEP/eTEP repairs while all robotic TAPP patients except EHS L1 received DCODS. Compared to without DCODS group, DCODS group had significantly lower proportion of seroma formation(1.41% vs. 46.34%, p value < 0.0001) and no significant difference in chronic groin pain at 6 months (1.41% vs. 7.32%, p value = 0.138).

Conclusion: DCODS significantly reduces the risk of seroma formation without increasing the post operative pain and incidence of chronic groin pain. DCODS appears to be easier with the use of robotic platform as it involves technically challenging suturing at odd angles.

Purpose: Incisional hernia (IH) is a common complication following abdominal surgery, particularly after liver transplantation (LT). Given the impact on quality of life and associated health and financial burdens, accurate risk prediction is important for guiding preventive strategies. This study aimed to externally validate the Transplant‑Specific Penn Hernia Risk Calculator and to develop a revised prediction model tailored to LT patients.

Methods: A retrospective cohort study was conducted of patients ≥ 18 years who underwent LT between 2010 and 2019 at a tertiary academic centre. External validation was conducted using the Transplant-Specific Penn Hernia Risk Calculator variables and their corresponding coefficients. A revised model was developed using a multi-step methodology to optimize predictive performance. The updated model included five additional predictor variables (age ≥ 60, NYHA functional class ≥ 2, history of previous hernia, retransplantation, and polycystic liver disease) added to three original predictors (arterial hypertension, history of GI surgery, and obesity WHO class 3). Model performance was assessed for discrimination, calibration, and overall accuracy.

Results: Of 308 LT recipients included, 55 (17.9%) developed an IH requiring surgical repair. Analysis was restricted to 280 patients (90.9%) with ≥ 1 year follow-up. The Transplant-Specific Penn Hernia Risk Calculator demonstrated suboptimal discrimination (area under the receiver-operating-characteristic curve [AUC] = 0.649) and calibration (observed-to-expected [O/E] ratio = 5.514). The revised LT-specific model achieved superior discrimination (AUC = 0.807) and excellent calibration (O/E ratio = 1.007).

Conclusion: By incorporating LT-specific variables, the revised model improves predictive performance, enabling improved risk stratification. This might increase interest of using preventive mesh placement in this patient category.