Hernia最新文献

Background: Parastomal hernia (PSH) is a debilitating long-term complication of stoma formation, often required as part of curative or palliative treatment for colorectal cancer. As a common downstream consequence of cancer surgery, PSH contributes significantly to chronic morbidity and impairs quality of life, yet practices surrounding its prevention and repair remain heterogeneous. Despite randomised evidence supporting prophylactic mesh, adoption is limited, and operative approaches to elective and emergency repair vary widely.

Methods: A cross-sectional survey of colorectal surgeons in Australia and New Zealand was conducted via the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) to assess current PSH management. The survey examined stoma creation practices, prophylactic and therapeutic mesh use, operative techniques, and responses to clinical vignettes. Subgroup analyses explored variation by surgeon seniority, practice setting, and country.

Results: Ninety-three surgeons responded (93/365, 25.5%), including 74/93 (79.6%) from Australia and 19/93 (20.4%) from New Zealand; 79/93 (84.9%) practised in metropolitan centres and 39/93 (41.9%) had > 15 years' experience. Routine prophylactic mesh use at stoma formation was reported by 11/93 (11.8%). For elective repair (n = 89), open access was preferred by 48/89 (53.9%) and Sugarbaker repair was the most common configuration (40/89, 44.9%). Technique selection differed by access: among surgeons favouring minimally invasive surgery (n = 41), 33/41 (80.5%) selected Sugarbaker, whereas those favouring open surgery (n = 48) more often selected keyhole (22/48, 45.8%) or retrorectus "sandwich" repair (18/48, 37.5%) (p < 0.00001). In the emergency small-bowel obstruction vignette, surgeons with > 15 years' experience more often favoured mesh use than those with ≤ 15 years (21/39, 53.8% vs 10/50, 20.0%; p = 0.0015). Overall operative volume was low, with 65/93 (69.9%) reporting 0-5 PSH repairs per year.

Conclusions: PSH prevention and repair across Australasia is marked by wide variability, low uptake of prophylactic mesh, and inconsistent technique selection. Operative approach strongly influenced repair configuration, and seniority appeared to drive emergency decision-making. Addressing PSH represents an important opportunity to reduce treatment-related morbidity in patients with pelvic malignancies undergoing stoma formation.

Purpose: Abdominal wall reconstruction in the presence of midline hernia (MH) and lateral hernia (LH) is a challenging procedure. The purpose of this study was to introduce surgical method combining the retromuscular sublay technique and component separation technique with mesh augmentation for the simultaneous repair of midline and lateral hernias.

Methods: Between January 2006 and January 2025, 67 consecutive patients who underwent abdominal wall reconstruction for combined MH and LH or parastomal hernia (PH) were retrospectively analysed. The abdominal wall was reconstructed using a combination of the retromuscular sublay technique and the component separation technique, followed by mesh reinforcement.

Results: Of 67 patients, 53 underwent reconstruction surgery for simultaneous MH and LH, and 14 patients underwent surgery for MH and PH. LH was incisional (after previous pararectal, oblique, subcostal, or "J" incisions) in 58.5%, at the site of stoma closure in 37.7%, and as a consequence of blunt trauma in 3.8%. The median total defect width was 15 cm (range, 11-18) for the entire cohort. The median operative time was 150 min. Overall morbidity was 17.9%. After a median follow-up period of 24 months (range, 1-58), recurrence developed in 2 (3%) patients and abdominal wall bulging in 1 (1.5%).

Conclusion: The combination of the retromuscular sublay technique, the component separation technique and mesh reinforcement is a safe and effective method for the simultaneous repair of MH and LH or PH.

Purpose: The management of hernia in immunocompromised patients remains a distinct surgical challenge, characterized by complex risk profiles, heightened susceptibility to infectious complications, and ambiguous consensus on optimal mesh selection and perioperative protocols. As the prevalence of immunosuppression continues to rise due to increasing organ transplant rates, autoimmune diseases, oncological therapies, and advanced age, understanding the nuances of mesh repair in this population is of paramount importance.

Methods: This review synthesizes current evidence on the safety, efficacy, and outcomes of hernia mesh repair in immunocompromised adults, traversing mesh materials, infection mitigation strategies, surgical techniques, recurrence and complication rates, patient-reported outcomes, cost-effectiveness, and future research imperatives.

Results: Advanced mesh materials-particularly long-acting resorbable meshes-show superior long-term durability but at elevated cost. The risk for mesh infection and recurrence is proportionate to immunosuppression burden, comorbidities, and operative field contamination. Notably, modern synthetic meshes, when coupled with stringent perioperative infection control and risk-mitigation strategies, offer durable repair with acceptable safety profiles, even in immunocompromised hosts.

Conclusion: There is insufficient evidence to support routine use of biologic mesh, except in select contaminated fields. Patient-reported metrics are increasingly recognized as essential for outcome assessment, though standardization remains incomplete. Cost-effectiveness favors synthetics unless contamination risks predominate or patient preference dictates otherwise. Gaps include inconsistent immunocompromised patient definitions, limited long-term data, and lack of tailored guidelines. Prospective, multicenter studies integrating real-world patient-reported and economic data are needed.

Purpose: Ruptured umbilical hernia (UH) is a life-threatening condition in cirrhotic patients with a morbidity and mortality rate of 30%. Despite its high risk, the best surgical treatment strategy for this condition remains controversial. This study aimed to evaluate the feasibility and safety of mesh repair of ruptured UH.

Methods: 149 patients who underwent surgical management for ruptured UH between January 2018 and December 2022 were included in this retrospective study. The patients were divided into two groups: anatomical repair (group 1, n = 92) and mesh repair (group 2, n = 57). Hernia recurrence, wound infection, and other perioperative morbidity and mortality were evaluated.

Results: The recurrence of hernia was significantly lower after mesh repair (5.3% vs. 17.4%, P = 0.03). Other postoperative complications were not significantly different between the two groups. However, the incidence of wound infection after mesh repair was higher than that after anatomical repair, but this was statistically non-significant (12.3% vs. 8.7%, p = 0.48). Two patients in the mesh repair group required mesh removal due to infection.

Conclusions: Mesh repair of ruptured UH in cirrhotic patients is a feasible and safe surgical option that results in a significantly lower hernia recurrence rate with acceptable morbidity and mortality, provided that careful patient optimization is carried out.

Purpose: To determine whether differences in operative approach and outcomes after ventral hernia repair (VHR) are primarily associated with case acuity and hernia complexity rather than surgeon practice grouping.

Methods: Adult VHRs recorded in the Abdominal Core Health Quality Collaborative (ACHQC)registry from 2013-2023 were analyzed. Cases were grouped by surgeon practice category (General Surgery [GS], Minimally Invasive Surgery [MIS], and Acute Care/Trauma Surgery [ACS]). Patient characteristics included demographics, ASA class, case urgency, operative approach, mesh width, and operative duration. Outcomes included recurrence at 30 days, 6 months, and 1 year (among patients with available follow-up) and health-related quality of life measured by HerQLes, with moderate-to-major improvement defined as a ≥20-point increase from baseline among patients with paired assessments.

Results: A total of 73,241 VHRs were analyzed (GS 56.2%, MIS 28.1%, ACS 15.6%). Operative approach distribution was similar across groups (open 63.8%, robotic 26.0%,laparoscopic 10.2%; p>0.05). ACS cases more frequently involved very large meshes (≥30 cm) and prolonged operative duration (>240 minutes), reflecting higher case complexity (both p<0.05). Early quality-of-life improvement at 30 days was most pronounced among ACS patients, whereas GS patients demonstrated the highest proportion of sustained moderate-to-major improvement at 6 months. Recurrence was uncommon at 30 days across all groups and increased with longer follow-up, with the highest 1-year recurrence observed among ACS patients.

Conclusions: In this large contemporary registry, operative approach selection was similar across surgeon practice groups. Differences in outcomes were most strongly associated with case urgency and hernia complexity rather than surgeon classification. Early quality-of-life gains were greatest in higher-acuity cases, while more durable improvements and lower long-term recurrence were observed in elective repair contexts. These findings underscore the dominant role of patient and case factors in determining VHR outcomes.