Hernia最新文献

Aim: The aim of this study was to explore patients' experiences of participation in a preoptimisation programme prior to ventral hernia repair, focusing on the programme's feasibility and patient-perceived potential.

Introduction: Preoptimisation of modifiable risk factors has received growing attention, but little is known about ventral hernia patients' perspectives on such programmes. Understanding patient motivation and perceived barriers is critical for designing effective interventions.

Method: Eight ventral hernia patients participated in a home-based preoptimisation programme lasting at least three weeks. Focus group interviews were conducted and analysed using reflexive thematic analysis.

Results: Participants generally perceived the preoptimisation programme positively. Clear and structured advice was valued, with participants appreciating straightforward instructions on physical activity and lifestyle change. Reported barriers included everyday life circumstances, orthopaedic comorbidities, and in some cases the hernia itself. Patients described perceived positive health effects, including improved fitness, weight loss, and better diabetes control. No adverse effects were raised during the interviews.

Conclusion: This is, to our knowledge, the first qualitative study of pre-optimisation programmes in ventral hernia surgery. As an exploratory, hypothesis-generating study, its findings are shaped by sample size and setting but provide novel insights that complement quantitative research by highlighting patient perspectives. Pre-optimisation programmes appear feasible and meaningful to ventral hernia patients, particularly when supported by clear guidance, structured follow-up, and surgeon involvement. The findings are discussed in the light of Self-Determination Theory, which emphasises internalisation of motivation through autonomy, competence, and relatedness.

Purpose: Incisional hernia is a common postoperative complication following abdominal surgery. Despite the use of synthetic meshes, recurrence rates remain high. This study aimed to develop and evaluate a biodegradable, aligned microfibrous scaffold to support wound healing and strengthen abdominal wall repair.

Methods: Scaffolds were fabricated from poly(ε-caprolactone) (PCL) using a controlled fiber-drawing technique to produce highly aligned microfibers with reproducible thickness and architecture. Their biocompatibility was examined in vitro using fibroblasts through adhesion and proliferation assays. For in vivo evaluation, the scaffolds were implanted over standardized abdominal wall incisions in rabbits. After six weeks, the regenerated tissue was harvested for mechanical testing to determine tensile strength and elasticity, while histological and immunohistochemical analyses assessed collagen type I deposition and neovascularization within the scaffold area.

Results: The aligned PCL scaffold promoted strong cell attachment and proliferation in vitro. In vivo, its application significantly increased tensile modulus compared with control wounds. Histological analysis revealed denser and more organized collagen deposition and a higher microvessel density in the scaffold-treated group, indicating enhanced tissue remodeling and vascular integration.

Conclusion: The aligned PCL microfibrous scaffold improved the mechanical and biological quality of the abdominal wall healing in vivo. These results suggest its potential for reducing the formation of incisional hernias and are suitable for further testing leading to use in clinical practice.

Purpose: During the COVID-19 pandemic, digital encounters became a crucial means of maintaining access to care amid restrictions on in-person interactions. As these limitations ease, it is essential to evaluate the outcomes of telehealth-based consultations. Before the pandemic, telehealth was predominantly used in postoperative care for surgical populations. This study examines the safety and efficacy of telehealth-based consultations compared to traditional in-person preoperative evaluations for small ventral hernia repair, contributing to the understanding of how telemedicine can be effectively integrated into surgical practices.

Methods: We utilized a prospectively maintained single-center database from a tertiary referral hospital with a specialized hernia and abdominal wall reconstruction team to compare preoperative, intraoperative, and postoperative variables between ventral hernia patients who received telehealth-based (phone or video) consultations and those who had any in-person clinic evaluation.

Results: A total of 187 patients with small (< 4 cm) ventral hernias were evaluated, with 42 (22%) being evaluated entirely through telemedicine-based consultations prior to their surgery. There were comparable post-operative outcomes for patients evaluated entirely virtually preoperative compared to those evaluated with at least one traditional in-person evaluation. In both cohorts, 52% of patients followed up at one-year through our hernia surveillance program. The unanticipated recurrence rates observed were 0% for digital pre-operative patients, and 2.01% for patients evaluated in person pre-operatively (p = 1).

Conclusions: Based on the data presented here, virtual preoperative encounters are as safe and effective as traditional in-person evaluations for patients with small ventral hernias.

Background: Incisional hernia (IH) is a significant complication that occurs after midline laparotomy and is associated with high morbidity and economic impacts. A fundamental goal of preventing IH is to determine which patients are considered low- or high-risk, as modifications in prevention techniques have been justified in high-risk patients.

Aim: of this study was to externally validate the IHXGBoost-P model to assess its accuracy, generalizability, and clinical applicability in an independent cohort.

Methods: A prospective cohort study was conducted in a tertiary hospital in Mexico (March 2021-December 2022) to externally validate the IHXGBoost-P model. Patients older than 18 years who underwent midline laparotomy and have a minimum follow-up of 24 months were included. The performance of the model was evaluated via area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, precision, specificity and calibration metrics.

Results: Of the 438 patients analyzed, 62 (14.1%) developed IH. The model demonstrated good discriminative capacity (Accuracy: 0.94 ± 0.015) and calibration (Brier score: 0.051). Key predictors included the risk of surgical site infection (odds ratio (OR): 3.01, 95% CI: 2.32-3.91), previous surgery, and body mass index (BMI). The specificity (0.97 ± 0.013) was determined to be high and useful for identifying lowrisk patients.

Conclusions: The IHXGBoost-P model is a reliable tool for predicting the risk of IH, with robust performance being observed in external validation. Its integration into clinical practice through a web application could optimize surgical decision-making to prevent IH.

Purpose: Inguinal hernias are commonly encountered during robotic-assisted radical prostatectomy (RARP), either preoperatively or intraoperatively. Performing concurrent inguinal hernia repair (IHR) at the time of RARP may prevent the morbidity, cost, and inconvenience associated with a second operation. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of concurrent IHR during RARP compared with RARP alone.

Methods: This study followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD42025646245). Comprehensive searches of PubMed, EMBASE, and Cochrane CENTRAL were conducted to identify studies comparing outcomes of RARP with and without concurrent IHR. Primary outcomes included operative time, length of hospital stay, blood loss, and postoperative complications. A proportional meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.

Results: Twenty studies comprising 1,402 patients who underwent concurrent IHR and 20,405 patients who underwent RARP alone were included. Concurrent IHR was associated with a statistically significant increase in operative time (mean difference 30.45 min; 95% CI 13.71-77.38) but showed no significant differences in postoperative complications, blood loss, or hospital stay. The pooled hernia recurrence rate was low (mean 1.9%), and Clavien-Dindo I-III complication rates were comparable between groups.

Conclusion: Concurrent IHR during RARP may be feasible, with perioperative outcomes broadly comparable to RARP alone. Concurrent repair may be considered in selected patients and experienced centres however given study heterogeneity and the predominance of retrospective evidence, these findings should be interpreted cautiously.

Trial registration: The trial was prospectively registered on PROSPERO on 03/02/2025 under ID: CRD42025646245.