Hernia最新文献

Introduction: There is an increasing adoption of e-TEP technique for inguinal hernia repair. However, there remains a lack of clarity regarding the criteria for selecting this technique and whether it leads to better clinical outcomes compared to standard laparoscopic methods. To address this gap, the present study analyzed data from the Indian Hernia Collaborative-a multicenter initiative of the Hernia Society of India (HSI) launched in 2022. The study aimed to assess the patterns of case selection and outcomes associated with e-TEP in comparison to TEP and TAPP.

Methods: The datasets were collected from 26 centres using a pre-designed Excel sheet. Each dataset included one-year follow-up data for all patients. A comparative analysis was conducted for patients who underwent laparoscopic groin hernia repair using one of three techniques: enhanced-view totally extraperitoneal (eTEP), transabdominal preperitoneal (TAPP), or totally extraperitoneal (TEP) repair.

Results: Of the 1,510 patients, 992 underwent laparoscopic groin hernia repair and the rest were open surgeries. Among them, 537 patients had bilateral repairs, resulting in a total of 1,529 individual laparoscopic procedures. The distribution of techniques was as follows: TAPP in 489 (49.3%), TEP in 489 (27.9%), and enhanced-view eTEP in 226 (22.8%) of cases. TAPP was more commonly selected for irreducible hernias. The eTEP technique was more often utilized in larger hernias (W3), compared to TEP. Mesh fixation was significantly more frequent in the TAPP group (97.7%) compared to the eTEP (86.7%) and TEP (38.2%) groups. Plication of the hernia sac was commonly performed in TAPP (20.2%), followed by TEP (5.85%) and e-TEP (2.38%), with the differences being statistically significant (p < 0.001). However, the operative duration was significantly longer for eTEP (87.3 min) and TAPP (94.1 min) than for TEP (70.2 min). Seroma, surgical site infection, hematoma, postoperative pain and recurrence rates were comparable across all three techniques.

Conclusion: In India, eTEP has seen a rapid rise in adoption amongst TEP surgeons and is increasingly being utilized for larger and more complex groin hernia repairs, however, there is no difference in short-term outcomes between the three procedures.

Objective: To evaluate the safety, efficacy, and long-term outcomes of concomitant laparoscopic bariatric surgery and ventral hernia repair in obese patients. Obesity and ventral hernia frequently coexist, often presenting a surgical dilemma. Historically, concerns over mesh infections, extended operative time, and increased morbidity have led to a preference for staged procedures. However, with advancements in laparoscopic techniques and increasing evidence supporting mesh placement in clean-contaminated fields, the concomitant approach has gained acceptance. High-quality data from large-volume centers remain limited till now.

Method: This retrospective study was conducted at a tertiary care center between January 2003 and December 2023. A total of 353 patients underwent simultaneous bariatric surgery-either laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), or mini-gastric bypass (MGB-OAGB)-with ventral hernia repair using intraperitoneal onlay mesh (IPOM), eTEP-Ventral RS, or eTEP-TAR techniques. The Primary objective of the study was to assess the complication and recurrence rates. Secondary objective included operative time, hospital stay, and postoperative recovery.

Results: Of the 353 patients, 224 underwent LSG, 74 LRYGB, and 55 MGB-OAGB. IPOM was used in 90% of cases. The overall complication rate was low, with seroma (2.3%), ileus (2.6%), hematoma (1.1%) and Surgical site occurrences (SSO) (3.4%) being the most common. No mesh infections or anastomotic leaks were observed. Mean operative time ranged from 124 to 167 min, and average hospital stay was 3.1 ± 1.1 days. At one-year follow-up in 268 patients (80%), hernia recurrence was 0.6%.

Conclusions: Concomitant laparoscopic bariatric surgery with hernia repair is a safe and effective option in appropriately selected patients, with excellent outcomes and minimal complications.

Background: Absorbable synthetic meshes have gained increasing acceptance for crural reinforcement during hiatus hernia (HH) repair because their safety profile and the potential of reducing recurrence rates. Bio-A^® (Gore Medical, Newark, DE, USA) and Phasix-ST^® (C.R. Bard, Inc./Davol, Inc., Warwick, RI, USA) are the most commonly used meshes. While previous single-arm studies have been published, there are no articles reporting the comparison between Phasix-ST^® vs. Bio-A^®.

Aim: Compare safety, efficacy, recurrence rates, and quality of life after laparoscopic HH repair and cruroplasty reinforced with either Bio-A^® or Phasix-ST^® mesh.

Methods: Retrospective multicenter study (September 2011- December 2024). All patients that underwent minimally invasive HH repair with Phasix-ST^® or Bio-A^® reinforced cruroplasty and Toupet fundoplication were included.

Results: Overall, 271 patients were included. Bio-A^® reinforcement was utilized in 46.8% of patients. The median follow-up time was 94 (IQR 21) months for Bio-A^® and 51 (IQR 17) months for Phasix-ST^® mesh. Hernia recurrence was diagnosed in 10.1% of patients with similar rates for Phasix-ST^® vs. Bio-A^® (7.8% vs. 12.6%; p = 0.28). The regression analysis showed that Phasix-ST^® (HR 0.66), 'keyhole' configuration (HR 0.81), hernia type III-IV (HR 1.38), and recurrent HH (HR 1.27) were not independent predictor or protective factors for recurrence. The 55-month recurrence free probability for Bio-A^® vs. Phasix-ST^® was comparable (86.2% vs. 91.8%; p = 0.132).

Conclusions: This study shows that Bio-A^® and Phasix-ST^® are equally safe for crural reinforcement during HH repair. Due to the longer absorption rate, Phasix ST^® might presumably confer enhanced hiatal protection early in the course of the follow-up.

Rectus diastasis repair can be approached in many different ways from robotic to open. However, a large part of the transformation a plastic surgeon can offer a patient who is seeking a diastasis repair is to combine the rectus diastasis repair with body contouring procedures. Patients with excess soft tissues, lax skin or lipodystrophy will benefit from a concomitant body contouring procedure, most commonly in some form of abdominoplasty. Minimally invasive options can be offered; however, patient selection is crucial for the optimal and expected outcome. For patients with a small amount of excess skin, liposuction or other-energy based procedures can be offered to enhance results. Patients should be properly educated on what surgery they are getting and the expected results that can be obtained.

Purpose: The aim of this study was to compare robotic-assisted versus laparoscopic techniques in elective primary minimally invasive inguinal hernia repair, focusing on intraoperative conversion rates, perioperative outcomes, and preoperative risk factors. Given the increasing adoption of robotic surgery, we sought to evaluate whether the proposed technical advantages translate into measurable clinical benefits in a real-world, multicenter population using a nationally representative database.

Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2022-2023). Adult patients undergoing elective minimally invasive inguinal hernia repair were identified using CPT code 49650. Patients were stratified into robotic and laparoscopic cohorts. Primary outcomes included conversion to open surgery and operative time; secondary outcomes included 30-day complications, mortality, hospital length of stay, and readmission. Statistical analyses included univariate and multivariate logistic regression.

Results: Of 34,257 cases analyzed, 54.9% were robotic and 45.1% laparoscopic. Robotic cases had significantly lower conversion to open rates (0.1% vs. 0.4%, p < 0.001) but longer operative times (82.5 vs. 65 min, p < 0.001). Perioperative complications, mortality, and readmission rates were comparable between groups. Multivariate analysis showed robotic surgery as an independent protective factor against conversion (OR 0.36, 95% CI: 0.22-0.57, p < 0.001).

Conclusion: Robotic-assisted inguinal hernia repair is associated with a lower conversion rate to open surgery without increased complications, despite longer operative times and a higher comorbidity burden. These findings support the selective use of robotics, particularly in complex cases, while highlighting the need for further cost-effectiveness and long-term outcomes research.

Purpose: Groin hernias are among the most common causes for surgical consult globally. This study analyzed the case profiles, management practices, and post-operative outcomes of emergency groin hernia repairs over a 7-year period in a tertiary government hospital in the Philippines.

Methods: A retrospective, descriptive, cross-sectional study was conducted of adult patients who underwent emergency groin hernia repair at the Philippine General Hospital between January 1, 2017 and December 31, 2023. Case characteristics, surgical approaches, and outcomes were examined. Inferential statistics were used to analyze the associations between risk factors and key outcomes (complications, mortality, and recurrence).

Results: Among 2,341 adult hernia admissions, 711 (30%) were emergencies; 551 of these underwent surgery. The emergency-to-total repair ratio (ET/H) was 26.3. Most patients were male (98%), with a mean age of 50.7. Most hernias were right-sided (61%), indirect (96%), and presented as acutely irreducible (68%). Strangulation was seen in 11%, and 6% were recurrent cases. The COVID-19 years showed reduced admissions and longer hospital stays. Lichtenstein repair was the most used technique overall (80%), while tissue repairs were preferred in 52% of strangulated cases. In the early post operative period, complication rate was 8% while mortality was 3%. Strangulation strongly predicted wound complications (OR 5.0, 95% CI 1.9-13.3, p = 0.003) and mortality (OR 16.3, 95% CI 5.3-50.4, p < 0.00001). Recurrence occurred in 2.6% of followed-up cases, and was significantly more likely in patients with comorbidities (OR 2.72, 95% CI 1.32-5.61, p = 0.0066).

Conclusions: Emergency hernia repair remains a significant surgical burden in the Philippines, reflecting gaps in surgical access, capacity, and early intervention. At PGH, most patients are young and present severely, with repairs performed predominantly by trainees using open techniques. Despite these constraints, outcomes remain within global standards, underscoring the need to standardize care and strengthen training and research.

Purpose: To compare long-term recurrence and reoperation outcomes in ventral hernia repairs (VHR) and abdominal wall reconstructions (AWR) using absorbable mesh (AM: synthetic and biologic) versus permanent mesh (PM) across CDC wound class 1-4.

Methods: Adult patients who underwent first-time elective VHR or AWR with mesh were identified using Kaiser Permanente's integrated electronic health record (2010-2023). PM repairs were 1:1 propensity score-matched to AM repairs. Cumulative incidence via the Kaplan-Meier estimate and multivariable Cox regression were used to evaluate risk for hernia recurrence and reoperation for recurrence; secondary analysis evaluated outcomes by wound class 1, 2, and 3/4.

Results: Among 24,822 VHR and 1,341 AWR, AM were used in 1,330 (5.4%) VHR and 290 (21.6%) AWR. After matching, the 10-year cumulative recurrence was 33.7% for VHR with AM versus 25.3% for PM and AM was associated with a higher risk of recurrence (HR = 1.40, 95% CI = 1.19-1.64) and reoperation (HR = 1.81, 95% CI = 1.28-2.56) versus PM. In VHR subset analysis, AM associated with a higher recurrence risk in wound class 1 (HR = 1.53, 95% CI = 1.21-1.94) and wound class 3/4 (HR = 2.20, 95% CI = 1.08-4.94) and reoperation risk in wound class 1 (HR = 1.65, 95% CI = 1.01-2.70) and wound class 2 (HR = 1.76, 95% CI = 1.01-3.06). Synthetic and biologic AM each had higher recurrence versus PM; biologic AM also had higher reoperation. For AWR, no differences were observed at 6 years.

Conclusion: In this large, long-term propensity-matched cohort, AM for VHR was associated with higher recurrence and reoperation risk than PM, including in contaminated fields.

Background: Accurate interpretation of computed tomography (CT) prior to ventral hernia repair (VHR) is critical for operative planning, particularly in recurrent cases where prior mesh type and placement influence surgical approach. While radiologists possess specialized expertise in imaging interpretation, their performance in identifying post-VHR mesh characteristics remains unstudied. This study assesses the diagnostic performance of radiologists in identifying mesh plane and type on CT following VHR.

Methods: Forty body radiologists from 16 centers evaluated 18 de-identified CT scans, including 12 post-VHR cases and 6 controls. After receiving standardized training on mesh characteristics and surgical planes, radiologists were tasked with identifying both the VHR mesh plane and the mesh type. The study assessed correct identification rates, interrater reliability, and repeatability.

Results: Radiologists demonstrated overall accuracy rates of 39.2% for mesh plane identification and 43.5% for mesh type identification. Accuracy was highest for intraperitoneal approaches (53.8%) and heavy-weight mesh (52.5%), with significantly lower accuracy (16.9-22.5%) for other surgical planes and mesh types (30.6%). Interrater reliability was poor (Gwet's AC1 = 0.127), with significant between-radiologist variability. Self-reported confidence levels correlated positively with accuracy rates, with high-confidence radiologists showing significantly better performance (OR 4.55, p < 0.001). Years of clinical experience did not predict diagnostic accuracy.

Conclusions: Radiologists demonstrated limited ability to accurately interpret post-VHR CT scans, even after targeted instruction. These diagnostic challenges mirror findings among abdominal wall reconstruction surgeons, suggesting inherent limitations in CT-based assessment rather than discipline-specific deficits. Multidisciplinary collaboration, standardized operative documentation, and dedicated abdominal wall imaging protocol and training are essential to improve diagnostic accuracy and optimize surgical planning.

Purpose: Abdominal wall reconstruction in patients with high-risk comorbidities and contamination is controversial. There is no standardized mesh choice for such clinical circumstances. We reviewed our experience of poly-4-hydroxybutyrate (P4HB) mesh for abdominal wall reconstruction in hostile abdomen after emergency and elective abdominal surgeries.

Methods: We performed a retrospective review of 48 patients with CDC class 3 or 4 contamination and high-risk comorbidities who underwent abdominal wall reconstruction with P4HB between June 2016-October 2019. Data collected included demographics, abdominal closure techniques, and long-term surgical site complications and hernia recurrence.

Results: Patients ranged from 33-88 years old; 70% were female. BMI ranged from 14-70 kg/m² (mean 36, SD ± 11.31). High-risk comorbidities were present in 75% of patients. Emergency abdominal closures were performed in 69% of patients. Underlay Phasix™ ST mesh was used in 71% of emergency and 53% of elective abdominal closures. Myofascial release was required in 21% of elective and 9% of emergency patients. Fascial negative pressure wound therapy was used in 45% of emergency and 20% of elective patients. Surgical site occurrences were seen in 42% of emergency and 53% of elective abdominal closures. At a mean follow-up of 41.8 months, hernias had recurred in 16% patients after emergency and 20% after elective procedures.

Conclusion: P4HB mesh is well tolerated and provides durable abdominal wall reconstruction with acceptable hernia recurrence after emergency and elective abdominal closure, making it a sensible option for abdominal closure in high-risk comorbidities and abdominal contamination.